Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2012;7(5):e36966. doi: 10.1371/journal.pone.0036966. Epub 2012 May 31.
We estimated the incremental cost and impact on diagnosis and treatment uptake of national rollout of Xpert MTB/RIF technology (Xpert) for the diagnosis of pulmonary TB above the cost of current guidelines for the years 2011 to 2016 in South Africa.
We parameterised a population-level decision model with data from national-level TB databases (n = 199,511) and implementation studies. The model follows cohorts of TB suspects from diagnosis to treatment under current diagnostic guidelines or an algorithm that includes Xpert. Assumptions include the number of TB suspects, symptom prevalence of 5.5%, annual suspect growth rate of 10%, and 2010 public-sector salaries and drug and service delivery costs. Xpert test costs are based on data from an in-country pilot evaluation and assumptions about when global volumes allowing cartridge discounts will be reached.
At full scale, Xpert will increase the number of TB cases diagnosed per year by 30%-37% and the number of MDR-TB cases diagnosed by 69%-71%. It will diagnose 81% of patients after the first visit, compared to 46% currently. The cost of TB diagnosis per suspect will increase by 55% to USD 60-61 and the cost of diagnosis and treatment per TB case treated by 8% to USD 797-873. The incremental capital cost of the Xpert scale-up will be USD 22 million and the incremental recurrent cost USD 287-316 million over six years.
Xpert will increase both the number of TB cases diagnosed and treated and the cost of TB diagnosis. These results do not include savings due to reduced transmission of TB as a result of earlier diagnosis and treatment initiation.
我们估算了在南非，2011 年至 2016 年期间，将 Xpert MTB/RIF 技术（Xpert）用于诊断肺结核的成本是否超过现行指南的成本，以及在全国范围内推广 Xpert 对肺结核诊断和治疗的影响。
我们使用国家结核病数据库（n=199511）和实施研究的数据来参数化人群水平的决策模型。该模型追踪从诊断到按照现行诊断指南或包括 Xpert 的算法接受治疗的结核疑似病例。假设包括结核疑似病例的数量、5.5%的症状流行率、每年 10%的疑似病例增长率以及 2010 年公共部门工资和药品及服务提供成本。Xpert 检测成本基于国内试点评估的数据和达到全球规模允许墨盒折扣时的假设。
全面推广 Xpert 将使每年诊断的结核病例数增加 30%-37%，耐多药结核病例数增加 69%-71%。与目前的 46%相比，它将在第一次就诊时诊断出 81%的患者。每个疑似病例的结核病诊断费用将增加 55%，达到 60-61 美元，每个经治疗的结核病例的诊断和治疗费用将增加 8%，达到 797-873 美元。Xpert 扩大规模的增量资本成本将为 2200 万美元，六年的增量经常性成本为 2.87-3.16 亿美元。
Xpert 将增加诊断和治疗的结核病例数量以及结核病诊断的成本。这些结果不包括由于更早诊断和治疗开始而减少的结核病传播所带来的节省。
