Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

Pinto, Márcia; Entringer, Aline Piovezan; Steffen, Ricardo Ewbank; Trajman, Anete

doi:10.1590/s1806-37562015000004524

Cited by 16 publications

(13 citation statements)

References 9 publications

(26 reference statements)

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“…Moreover, the unit cost per test was high for the GeneXpert-based algorithm compared to the conventional smear microscope technique. This is consistent with studies conducted in Brazil and India [24,25] and South Africa [26]. This relatively high cost might be due to expensive equipment and cartridge and high maintenance costs required by the GeneXpert algorithm compared to the routine smear microscopy method.…”

Section: Discussionsupporting

confidence: 89%

Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

Kaso¹,

Hailu²

2020

Preprint

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Background Early diagnosis is one of the pillars of the TB (TB) control, and there are strong efforts to detect and treat cases in Ethiopia. Smear microscopy testing has been a routine test for the diagnosis of pulmonary TB in resource-constrained settings for a long time. Recently, many countries, including Ethiopia, are scaling up the use of GeneXpert without a precise evaluation of the cost and cost-effectiveness of this technology. Therefore, this study aimed to evaluate the cost-effectiveness of GeneXpert compared to smear microscopy tests for the diagnosis of TB patients in Ethiopia. Methods We develop a decision tree model using TreeAge Pro 2020 software. The model accounts for the prevalence and incidence of TB in the study area. The costs were estimated from the health providers' perspective in one year (in 2017/18). We applied an ingredients-based costing approach to identify, measure, and evaluate the smear microscopy cost and GeneXpert. We employed the 'proportion of cases detected' as an outcome measure of effectiveness. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the changes in cost and change effectiveness. One way and probabilistic sensitivity analysis were done by varying different input parameters. All costs and ICER are reported in 2018 US$. Results The unit cost per test for GeneXpert and smear microscopy testing was US$12.9 and $3.1, respectively. The average cost of testing using GeneXpert was $113.0 and $3.3 for smear microscopy. The cost of the cartridge ($10.7) was the primary (83%) parameter influencing the overall cost of GeneXpert, while it was the cost of reagent and consumables $1.28 (41%) for the smear microscopy. The ICER for GeneXpert strategy was $729.8 per new TB cases detected compared to smear microscopy. The sensitivity analysis indicates that TB prevalence was the most influential parameter on the ICER. Conclusion The present study indicates that testing all individuals with suspected TB using GeneXpert is a very cost-effective strategy compared to smear microscopy, and therefore, it can be part of the routine diagnostic testing strategy in Ethiopia.

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Section: Discussionsupporting

confidence: 89%

Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

Kaso¹,

Hailu²

2020

Preprint

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“…In our study, since we used only the mean cost, and not the activity based cost (ABC), we adopted the apportionment method to cope with any distortions, when we consider the proportion of the laboratory expenses with the exam considered. We observed the cost with Xpert (US$24.61) to be higher than the cost reported by Pinto et al(US$17.35) 13 in our country, and by Shah et al 23 ($14.93), but lower than the cost (US$60-61) reported in South Africa 24 . However, since it was not possible to perform a costeffectiveness analysis, we cannot compare our data with the unfavorable data reported by Vassal et al l6 and by Pinto et al 25 .…”

Section: Discussioncontrasting

confidence: 68%

“…In a clinical trial performed in the Cities of Rio de Janeiro and Manaus, using secondary data obtained from the Integrated Laboratory System (ILS) and Disease Notification system (DNS), compared to SSM, the use of Xpert resulted in a) a higher proportion of bacteriologically-confirmed TB, a shorter time to treatment initiation 12 , and a lower cost 13 , but there was no impact on TB treatment outcomes 14 . Under this scenario, the Xpert test was introduced into the Brazilian Health System in 2013 15 .…”

Section: Introductionmentioning

confidence: 99%

Clinical impact and cost analysis of the use of either the Xpert MTB Rif test or sputum smear microscopy in the diagnosis of pulmonary tuberculosis in Rio de Janeiro, Brazil

Castro

Moreira

Oliveira

et al. 2018

Rev. Soc. Bras. Med. Trop.

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Introduction: The molecular test Xpert MTB/RIF (Xpert) has been recommended for use in the diagnosis of pulmonary tuberculosis (PTB); however, data on the cost of incorporating it under routine conditions in high-burden countries are scarce. The clinical impact and costs incurred in adopting the Xpert test in routine PTB diagnosis was evaluated in a prospective study conducted from November 2012 to November of 2013, in the City of Rio de Janeiro, Brazil. Methods: The diagnostic and therapeutic cascade for TB treatment was evaluated using Xpert in the first stage (S1), and sputum smear microscopy (SSM) in the second stage (S2). The mean costs associated with each diagnostic test were calculated including equipment, human resources, supplies, and infrastructure. Results: We included 232 subjects with probable TB (S1 = 87; S2 = 145). The sensitivities of Xpert and SSM were 91.7% (22/24) and 79.1% (34/43), respectively. The median time between triage and TB treatment initiation in S1 (n = 24) was 14.5 days (IQR 8-28.0) and in S2 (n = 43) it was 8 days [interquartile range (IQR) 6-12.0]. The estimated mean costs per examination in S1 and S2 were US$24.61 and US$6.98, respectively. Conclusions: Compared with SSM, Xpert test showed a greater sensitivity, but it also had a time delay with respect to treatment initiation and a higher mean cost per examination.

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“…In countries where the incidence of TB is intermediate, like in Brazil, information on Xpert MTB/RIF is lacking [12]. Given the potentialities https://doi.org/10.1016/j.rmed.2017.11.012 Received 15 September 2017; Received in revised form 10 October 2017; Accepted 20 November 2017 of the test to improve TB diagnosis in Brazil, this study was designed to evaluate the diagnostic performances of the test in the HIV-uninfected andinfected patients (sensitivity, specificity, positive and negative predictive values) within the framework of the ERS (European Respiratory Society)/SBPT (Brazilian Society of Respiratory Diseases) collaborative TB project.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performances of the Xpert MTB/RIF in Brazil

Silva

Sotgiu

D’Ambrosio

et al. 2018

Respiratory Medicine

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Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

Cited by 16 publications

References 9 publications

Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

Cost-effectiveness of GeneXpert Compared to Smear Microscopy for Diagnosis of Tuberculosis in Ethiopia

Clinical impact and cost analysis of the use of either the Xpert MTB Rif test or sputum smear microscopy in the diagnosis of pulmonary tuberculosis in Rio de Janeiro, Brazil

Diagnostic performances of the Xpert MTB/RIF in Brazil

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