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Cost-effectiveness of Xpert ®MTB/RIF in the diagnosis of tuberculosis: pragmatic study

Authors
  • da Silva, Suely Conceição Alves1
  • Vater, Maria Claudia1, 2
  • Ramalho, Daniela Maria de Paula1
  • de Almeida, Isabela Neves3, 4
  • de Miranda, Silvana Spíndola3
  • Kritski, Afrânio1
  • 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
Type
Published Article
Journal
Revista da Sociedade Brasileira de Medicina Tropical
Publisher
Sociedade Brasileira de Medicina Tropical - SBMT
Publication Date
Feb 10, 2021
Volume
54
Identifiers
DOI: 10.1590/0037-8682-0755-2020
PMID: 33605382
PMCID: PMC7891564
Source
PubMed Central
Keywords
License
Green

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.

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