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. 2023 May 22;23(1):341.
doi: 10.1186/s12879-023-08330-9.

Pooling sputum testing to diagnose tuberculosis using xpert MTB/RIF and xpert ultra: a cost-effectiveness analysis

Vibol Iem  1   2 , John S Bimba  3 , Victor S Santos  4   5 , Jose Dominguez  6 , Jacob Creswell  7 , Silaphet Somphavong  8 , Tom Wingfield  9   10 , Jahangir A M Khan #  11 , Luis E Cuevas #  9
Affiliations

Pooling sputum testing to diagnose tuberculosis using xpert MTB/RIF and xpert ultra: a cost-effectiveness analysis

Vibol Iem et al. BMC Infect Dis. .

Abstract

Background: The World Health Organization (WHO) recommends the diagnosis of tuberculosis (TB) using molecular tests, such as Xpert MTB/RIF (MTB/RIF) or Xpert Ultra (Ultra). These tests are expensive and resource-consuming, and cost-effective approaches are needed for greater coverage.

Methods: We evaluated the cost-effectiveness of pooling sputum samples for TB testing by using a fixed amount of 1,000 MTB/RIF or Ultra cartridges. We used the number of people with TB detected as the indicator for cost-effectiveness. Cost-minimization analysis was conducted from the healthcare system perspective and included the costs to the healthcare system using pooled and individual testing.

Results: There was no significant difference in the overall performance of the pooled testing using MTB/RIF or Ultra (sensitivity, 93.9% vs. 97.6%, specificity 98% vs. 97%, p-value > 0.1 for both). The mean unit cost across all studies to test one person was 34.10 international dollars for the individual testing and 21.95 international dollars for the pooled testing, resulting in a savings of 12.15 international dollars per test performed (35.6% decrease). The mean unit cost per bacteriologically confirmed TB case was 249.64 international dollars for the individual testing and 162.44 international dollars for the pooled testing (34.9% decrease). Cost-minimization analysis indicates savings are directly associated with the proportion of samples that are positive. If the TB prevalence is ≥ 30%, pooled testing is not cost-effective.

Conclusion: Pooled sputum testing can be a cost-effective strategy for diagnosis of TB, resulting in significant resource savings. This approach could increase testing capacity and affordability in resource-limited settings and support increased testing towards achievement of WHO End TB strategy.

Keywords: Cost-effectiveness; Cost-minimization analysis; Pooling; Tuberculosis; Xpert MTB/RIF; Xpert Ultra.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the sputum processing* *Same test was used for individual and pooled testing (either Xpert MTB/RIF or Xpert Ultra).
Fig. 2
Fig. 2
Parameters affecting the pooled testing cost-effectiveness
Fig. 3
Fig. 3
Effect of the prevalence of the disease on the amount of savings by pooling method
See this image and copyright information in PMC

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References

    1. World Health Organization. Global tuberculosis report 2021. 2021.
    1. World Health Organization. WHO consolidated guidelines on tuberculosis. Module 3: diagnosis - rapid diagnostics for tuberculosis detection, 2021 update. 2021.
    1. Lawn SD, Nicol MP. Xpert MTB/RIF assay: development, evaluation and implementation of a new rapid molecular diagnostic for tuberculosis and rifampicin resistance. 2011(1746 – 0921 (Electronic)). - PMC - PubMed
    1. Chakravorty S, Simmons AM, Rowneki M et al. The New Xpert MTB/RIF Ultra: improving detection of Mycobacterium tuberculosis and Resistance to Rifampin in an assay suitable for point-of-care testing. mBio 2017: 8(4). - PMC - PubMed
    1. World Health Organization. WHO meeting report of a technical expert consultation: non-inferiority analysis of Xpert MTF/RIF Ultra compared to Xpert MTB/RIF. 2017.

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