Hassan Shoaib, Mustafa Tehmina, Muller William, Torres Lisete, Marijani Msafiri, Ngadaya Esther, Mfinanga Sayoki, Lema Yakobo, Grønningen Erlend, Jorstad Melissa, Norheim Ole, Robberstad Bjarne
Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway.
PLOS Glob Public Health. 2024 Aug 8;4(8):e0003414. doi: 10.1371/journal.pgph.0003414. eCollection 2024.
Extrapulmonary Tuberculosis (EPTB) poses challenges from patient and health system perspectives. The cost-effectiveness analysis of the Xpert MTB/RIF (Xpert) test to diagnose pulmonary tuberculosis is documented. However, there are no economic evaluations for EPTB. Considering the reported better diagnostic sensitivity of the MPT64 test, this study explored its cost-effectiveness as an alternative diagnostic test. We conducted this economic evaluation to assess the cost-effectiveness of the MPT64 test compared to Xpert and ZN microscopy for EPTB adult patients. We utilised a Markov modelling approach to capture short- and long-term costs and benefits from a health system perspective. For the model inputs, we combined data from our cohort studies in Tanzania and peer-reviewed EPTB literature. We calculated the Incremental Cost Effectiveness Ratio (ICER) by comparing the cost (in USD) of each diagnostic test and Quality Adjusted Life Years (QALYs) as health gain. We found the MPT64 test cost-effective for EPTB diagnosis and absolutely dominated ZN microscopy and Xpert using the baseline model inputs. A scenario analysis showed that the Xpert test might be the most cost-effective at its higher test sensitivity, which corresponds to using it to diagnose lymph node aspirates. The prevalence of HIV among EPTB cases, their probability of treatment, costs of ART, and the probability of the MPT64 test in detecting EPTB patients were the main parameters associated with the highest impact on ICER in one-way deterministic analysis. The most cost-effective option for EPTB at the baseline parameters was the MPT64 diagnostic test. Including the MPT64 test in EPTB diagnostic pathways for previously untreated patients can lead to better resource use. The Xpert test was the most cost-effective diagnostic intervention at a higher diagnostic test sensitivity in scenario analyses based on different sites of infection, such as for the lymph node aspirates.
肺外结核病（EPTB）从患者和卫生系统的角度来看都带来了挑战。已有关于Xpert MTB/RIF（Xpert）检测诊断肺结核的成本效益分析记录。然而，对于EPTB尚无经济评估。考虑到报告显示MPT64检测具有更好的诊断敏感性，本研究探讨了其作为替代诊断检测的成本效益。我们进行了这项经济评估，以评估MPT64检测与Xpert和ZN显微镜检查相比，对EPTB成年患者的成本效益。我们采用马尔可夫建模方法，从卫生系统的角度捕捉短期和长期成本及效益。对于模型输入，我们结合了来自坦桑尼亚队列研究的数据以及经过同行评审的EPTB文献。我们通过比较每种诊断检测的成本（以美元计）和作为健康收益的质量调整生命年（QALYs）来计算增量成本效益比（ICER）。我们发现，使用基线模型输入时，MPT64检测对于EPTB诊断具有成本效益，并且绝对优于ZN显微镜检查和Xpert。情景分析表明，在较高检测敏感性下，Xpert检测可能是最具成本效益的，这对应于用它来诊断淋巴结抽吸物。EPTB病例中的HIV流行率、其治疗概率、抗逆转录病毒疗法（ART）成本以及MPT64检测检测EPTB患者的概率是在单向确定性分析中对ICER影响最大的主要参数。在基线参数下，EPTB最具成本效益的选择是MPT64诊断检测。将MPT64检测纳入既往未治疗患者的EPTB诊断途径可导致更好的资源利用。在基于不同感染部位（如淋巴结抽吸物）的情景分析中，Xpert检测在较高诊断检测敏感性下是最具成本效益的诊断干预措施。
