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Feb 8, 2013Article Details
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Main Article Content
Diagnosing Xpert MTB/RIF-negative TB: Impact and cost of alternative algorithms for South Africa
Abstract
Methods. An existing population-level decision model was used. Costs were estimated from Xpert implementation studies and public sector
price and salary data. The number of patients requiring diagnosis was estimated from the literature, as were rates of TB treatment uptake
and loss to follow-up. TB and HIV positivity rates were estimated from the national TB register and laboratory databases.
Results. At national programme scale in 2014, X/X (R969 million/year) is less expensive than X/C R1 095 million/year), potentially saving R126
million/year (US$17.4 million). However, because Xpert is less sensitive than culture, X/X diagnoses 2% fewer TB cases. This is partly offset by
higher expected treatment uptake with X/X due to the faster availability of results, resulting in 1% more patients initiating treatment under X/X
than X/C. The cost per TB patient initiated on treatment under X/X is R2 682, which is 12% less than under X/C (R3 046).
Conclusions. Modifying the diagnostic algorithm from X/C to X/X could provide rapid results, simplify diagnostic processes, improve HIV/TB treatment outcomes, and generate cost savings.
