Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation.
BACKGROUND:Tuberculosis (TB) remains a significant health problem in the Canadian Arctic. Substantial health system delays in TB diagnosis can occur, in part due to the lack of capacity for onsite microbiologic testing. A study recently evaluated the yield and impact of a rapid automated PCR test (X...
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ftdoajarticles:oai:doaj.org/article:d1967dc2c73f4d8a89bae24bb4a861ce 2023-05-15T15:00:53+02:00 Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation. Olivia Oxlade Jordan Sugarman Gonzalo G Alvarez Madhukar Pai Kevin Schwartzman 2016-01-01T00:00:00Z https://doi.org/10.1371/journal.pone.0150119 https://doaj.org/article/d1967dc2c73f4d8a89bae24bb4a861ce EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC4798714?pdf=render https://doaj.org/toc/1932-6203 1932-6203 doi:10.1371/journal.pone.0150119 https://doaj.org/article/d1967dc2c73f4d8a89bae24bb4a861ce PLoS ONE, Vol 11, Iss 3, p e0150119 (2016) Medicine R Science Q article 2016 ftdoajarticles https://doi.org/10.1371/journal.pone.0150119 2022-12-31T14:31:27Z BACKGROUND:Tuberculosis (TB) remains a significant health problem in the Canadian Arctic. Substantial health system delays in TB diagnosis can occur, in part due to the lack of capacity for onsite microbiologic testing. A study recently evaluated the yield and impact of a rapid automated PCR test (Xpert®MTB/RIF) for the diagnosis of TB in Iqaluit (Nunavut). We conducted an economic analysis to evaluate the expected cost relative to the expected reduction in time to treatment initiation, with the addition of Xpert®MTB/RIF to the current diagnostic and treatment algorithms used in this setting. METHODS:A decision analysis model compared current microbiologic testing to a scenario where Xpert®MTB/RIF was added to the current diagnostic algorithm for active TB, and incorporated costs and clinical endpoints from the Iqaluit study. Several sensitivity analyses that considered alternative use were also considered. We estimated days to TB diagnosis and treatment initiation, health system costs, and the incremental cost per treatment day gained for each individual evaluated for possible TB. RESULTS:With the addition of Xpert®MTB/RIF, costs increased while days to TB treatment initiation were reduced. The incremental cost per treatment day gained (per individual investigated for TB) was $164 (95% uncertainty range $85, $452). In a sensitivity analysis that considered hospital discharge after a single negative Xpert®MTB/RIF, the Xpert®MTB/RIF scenario was cost saving. INTERPRETATION:Adding Xpert®MTB/RIF to the current diagnostic algorithm for TB in Nunavut appears to reduce time to diagnosis and treatment at reasonable cost. It may be especially well suited to overcome some of the other logistical barriers that are unique to this and other remote communities. Article in Journal/Newspaper Arctic Iqaluit Nunavut Directory of Open Access Journals: DOAJ Articles Arctic Nunavut Rif ENVELOPE(-16.172,-16.172,66.526,66.526) PLOS ONE 11 3 e0150119 |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
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Medicine R Science Q |
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Medicine R Science Q Olivia Oxlade Jordan Sugarman Gonzalo G Alvarez Madhukar Pai Kevin Schwartzman Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation. |
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Medicine R Science Q |
description |
BACKGROUND:Tuberculosis (TB) remains a significant health problem in the Canadian Arctic. Substantial health system delays in TB diagnosis can occur, in part due to the lack of capacity for onsite microbiologic testing. A study recently evaluated the yield and impact of a rapid automated PCR test (Xpert®MTB/RIF) for the diagnosis of TB in Iqaluit (Nunavut). We conducted an economic analysis to evaluate the expected cost relative to the expected reduction in time to treatment initiation, with the addition of Xpert®MTB/RIF to the current diagnostic and treatment algorithms used in this setting. METHODS:A decision analysis model compared current microbiologic testing to a scenario where Xpert®MTB/RIF was added to the current diagnostic algorithm for active TB, and incorporated costs and clinical endpoints from the Iqaluit study. Several sensitivity analyses that considered alternative use were also considered. We estimated days to TB diagnosis and treatment initiation, health system costs, and the incremental cost per treatment day gained for each individual evaluated for possible TB. RESULTS:With the addition of Xpert®MTB/RIF, costs increased while days to TB treatment initiation were reduced. The incremental cost per treatment day gained (per individual investigated for TB) was $164 (95% uncertainty range $85, $452). In a sensitivity analysis that considered hospital discharge after a single negative Xpert®MTB/RIF, the Xpert®MTB/RIF scenario was cost saving. INTERPRETATION:Adding Xpert®MTB/RIF to the current diagnostic algorithm for TB in Nunavut appears to reduce time to diagnosis and treatment at reasonable cost. It may be especially well suited to overcome some of the other logistical barriers that are unique to this and other remote communities. |
format |
Article in Journal/Newspaper |
author |
Olivia Oxlade Jordan Sugarman Gonzalo G Alvarez Madhukar Pai Kevin Schwartzman |
author_facet |
Olivia Oxlade Jordan Sugarman Gonzalo G Alvarez Madhukar Pai Kevin Schwartzman |
author_sort |
Olivia Oxlade |
title |
Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation. |
title_short |
Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation. |
title_full |
Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation. |
title_fullStr |
Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation. |
title_full_unstemmed |
Xpert®MTB/RIF for the Diagnosis of Tuberculosis in a Remote Arctic Setting: Impact on Cost and Time to Treatment Initiation. |
title_sort |
xpert®mtb/rif for the diagnosis of tuberculosis in a remote arctic setting: impact on cost and time to treatment initiation. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2016 |
url |
https://doi.org/10.1371/journal.pone.0150119 https://doaj.org/article/d1967dc2c73f4d8a89bae24bb4a861ce |
long_lat |
ENVELOPE(-16.172,-16.172,66.526,66.526) |
geographic |
Arctic Nunavut Rif |
geographic_facet |
Arctic Nunavut Rif |
genre |
Arctic Iqaluit Nunavut |
genre_facet |
Arctic Iqaluit Nunavut |
op_source |
PLoS ONE, Vol 11, Iss 3, p e0150119 (2016) |
op_relation |
http://europepmc.org/articles/PMC4798714?pdf=render https://doaj.org/toc/1932-6203 1932-6203 doi:10.1371/journal.pone.0150119 https://doaj.org/article/d1967dc2c73f4d8a89bae24bb4a861ce |
op_doi |
https://doi.org/10.1371/journal.pone.0150119 |
container_title |
PLOS ONE |
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11 |
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3 |
container_start_page |
e0150119 |
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