Cost-effectiveness of Xpert®MTB/RIF in the diagnosis of tuberculosis: pragmatic study
The intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xp...
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| Published in | Revista da Sociedade Brasileira de Medicina Tropical Vol. 54; p. e07552020 |
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| Main Authors | , , , , , |
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| Language | English Portuguese |
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Sociedade Brasileira de Medicina Tropical - SBMT
01.01.2021
Sociedade Brasileira de Medicina Tropical (SBMT) |
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| Abstract | The intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xpert) in the diagnosis of drug-resistant tuberculosis in reference units, in scenarios with and without subsidies, and the respective cost adjustment for today.
The analyses were performed considering as criterion of effectiveness, negative culture or clinical improvement in the sixth month of follow-up. The comparison was performed using two diagnostic strategies for the drug susceptibility test (DST), BactecTMMGITTM960 System, versus Xpert. The cost effectiveness and incremental cost-effectiveness ratio (ICER) were calculated and dollar-corrected for American inflation (US$ 1.00 = R$ 5,29).
Subsidized Xpert had the lowest cost of US$ 33.48 (R$67,52) and the highest incremental average efficiency (13.57), thus being a dominated analysis. After the inflation was calculated, the mean cost was DST-MGIT=US$ 74.85 (R$ 396,73) and Xpert = US$ 37.33 (R$197,86) with subsidies.
The Xpert in the diagnosis of TB-DR in these reference units was cost-effective with subsidies. In the absence of a subsidy, Xpert in TB-DR is not characterized as cost effective. This factor reveals the vulnerability of countries dependent on international organizations' subsidy policies. |
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| AbstractList | The intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xpert) in the diagnosis of drug-resistant tuberculosis in reference units, in scenarios with and without subsidies, and the respective cost adjustment for today.
The analyses were performed considering as criterion of effectiveness, negative culture or clinical improvement in the sixth month of follow-up. The comparison was performed using two diagnostic strategies for the drug susceptibility test (DST), BactecTMMGITTM960 System, versus Xpert. The cost effectiveness and incremental cost-effectiveness ratio (ICER) were calculated and dollar-corrected for American inflation (US$ 1.00 = R$ 5,29).
Subsidized Xpert had the lowest cost of US$ 33.48 (R$67,52) and the highest incremental average efficiency (13.57), thus being a dominated analysis. After the inflation was calculated, the mean cost was DST-MGIT=US$ 74.85 (R$ 396,73) and Xpert = US$ 37.33 (R$197,86) with subsidies.
The Xpert in the diagnosis of TB-DR in these reference units was cost-effective with subsidies. In the absence of a subsidy, Xpert in TB-DR is not characterized as cost effective. This factor reveals the vulnerability of countries dependent on international organizations' subsidy policies. INTRODUCTIONThe intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xpert) in the diagnosis of drug-resistant tuberculosis in reference units, in scenarios with and without subsidies, and the respective cost adjustment for today.METHODSThe analyses were performed considering as criterion of effectiveness, negative culture or clinical improvement in the sixth month of follow-up. The comparison was performed using two diagnostic strategies for the drug susceptibility test (DST), BactecTMMGITTM960 System, versus Xpert. The cost effectiveness and incremental cost-effectiveness ratio (ICER) were calculated and dollar-corrected for American inflation (US$ 1.00 = R$ 5,29).RESULTSSubsidized Xpert had the lowest cost of US$ 33.48 (R$67,52) and the highest incremental average efficiency (13.57), thus being a dominated analysis. After the inflation was calculated, the mean cost was DST-MGIT=US$ 74.85 (R$ 396,73) and Xpert = US$ 37.33 (R$197,86) with subsidies.CONCLUSIONSThe Xpert in the diagnosis of TB-DR in these reference units was cost-effective with subsidies. In the absence of a subsidy, Xpert in TB-DR is not characterized as cost effective. This factor reveals the vulnerability of countries dependent on international organizations' subsidy policies. Abstract INTRODUCTION: The intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xpert) in the diagnosis of drug-resistant tuberculosis in reference units, in scenarios with and without subsidies, and the respective cost adjustment for today. METHODS: The analyses were performed considering as criterion of effectiveness, negative culture or clinical improvement in the sixth month of follow-up. The comparison was performed using two diagnostic strategies for the drug susceptibility test (DST), BactecTMMGITTM960 System, versus Xpert. The cost effectiveness and incremental cost-effectiveness ratio (ICER) were calculated and dollar-corrected for American inflation (US$ 1.00 = R$ 5,29). RESULTS: Subsidized Xpert had the lowest cost of US$ 33.48 (R$67,52) and the highest incremental average efficiency (13.57), thus being a dominated analysis. After the inflation was calculated, the mean cost was DST-MGIT=US$ 74.85 (R$ 396,73) and Xpert = US$ 37.33 (R$197,86) with subsidies. CONCLUSIONS: The Xpert in the diagnosis of TB-DR in these reference units was cost-effective with subsidies. In the absence of a subsidy, Xpert in TB-DR is not characterized as cost effective. This factor reveals the vulnerability of countries dependent on international organizations’ subsidy policies. |
| Author | Silva, Suely Conceição Alves da Almeida, Isabela Neves de Kritski, Afrânio Ramalho, Daniela Maria de Paula Vater, Maria Claudia Miranda, Silvana Spíndola de |
| AuthorAffiliation | 1 Universidade Federal do Rio de Janeiro, Programa Acadêmico de Tuberculose, Rio de Janeiro, RJ, Brasil 2 Universidade Federal do Rio de Janeiro, Núcleo de Bioética e Ética Aplicada, Rio de Janeiro, RJ, Brasil 3 Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório de Pesquisa em Micobactérias, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil 4 Universidade Federal de Ouro Preto, Escola de Farmácia, Departamento de Análises Clínicas, Ouro Preto, MG, Brasil |
| AuthorAffiliation_xml | – name: 3 Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório de Pesquisa em Micobactérias, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil – name: 1 Universidade Federal do Rio de Janeiro, Programa Acadêmico de Tuberculose, Rio de Janeiro, RJ, Brasil – name: 2 Universidade Federal do Rio de Janeiro, Núcleo de Bioética e Ética Aplicada, Rio de Janeiro, RJ, Brasil – name: 4 Universidade Federal de Ouro Preto, Escola de Farmácia, Departamento de Análises Clínicas, Ouro Preto, MG, Brasil – name: Universidade Federal de Minas Gerais – name: Universidade Federal de Ouro Preto – name: Universidade Federal do Rio de Janeiro |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33605382$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.15171/ijhpm.2016.83 10.1371/journal.pmed.1001766 10.1186/s12879-017-2669-1 10.1371/journal.pone.0150487 10.1186/1471-2334-14-2 10.1016/S2214-109X(17)30205-X 10.1016/S2214-109X(18)30458-3 10.1056/NEJMoa0907847 10.1183/13993003.00543-2016 10.1017/S0266462319003398 |
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| Keywords | Multidrug-resistant tuberculosis Xpert MTB/RIF Innovation New diagnostics Cost-effectiveness |
| Language | English Portuguese |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Conflict of Interest: The authors declare that there is no conflict of interest. Authors’ contribution: SCAS: Conception and design of the study, Acquisition of data, Analysis and interpretation of data, design the methodology of the study, validation of data, Drafting the article, Final approval of the version to be submitted; MCV: Conception and design of the study, Lead the data curation, Analysis and interpretation of data, design the methodology of the study, validation of data, supervision and administration of the project, Drafting the article, Final approval of the version to be submitted; DMPR: Conception and design of the study, Acquisition of data, Analysis and interpretation of data, design the methodology of the study, validation of data, Drafting the article, Final approval of the version to be submitted; INA: Analysis and interpretation of data, supporting on design the methodology of the study, validation of data, Drafting the article, Final approval of the version to be submitted; SSM: Analysis and interpretation of data, supporting on design the methodology of the study, validation of data, Drafting the article, Final approval of the version to be submitted; ALK: Conception and design of the study, Lead the data curation, Lead the Funding acquisition, Analysis and interpretation of data, design the methodology of the study, validation of data, supervision and administration of the project, Drafting the article, Final approval of the version to be submitted. |
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| SubjectTerms | Cost-Benefit Analysis Cost-effectiveness Humans Innovation Major Multidrug-resistant tuberculosis Mycobacterium tuberculosis - genetics New diagnostics Sensitivity and Specificity TROPICAL MEDICINE Tuberculosis - diagnosis Tuberculosis, Multidrug-Resistant - diagnosis Xpert MTB/RIF |
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| Title | Cost-effectiveness of Xpert®MTB/RIF in the diagnosis of tuberculosis: pragmatic study |
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