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

• Published in: Revista da Sociedade Brasileira de Medicina Tropical
• Main Authors: Suely Conceição Alves da Silva, Maria Claudia Vater, Daniela Maria de Paula Ramalho, Isabela Neves de Almeida, Silvana Spíndola de Miranda, Afrânio Kritski
• Format: Article in Journal/Newspaper
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT) 2021
• Subjects: Multidrug-resistant tuberculosis; Cost-effectiveness; New diagnostics; Xpert MTB/RIF; Innovation; Arctic medicine. Tropical medicine; RC955-962; Arctic; Rif
• Online Access: https://doi.org/10.1590/0037-8682-0755-2020; https://doaj.org/article/d6ef3f7a1a564c96a91f347c6e14b9ea

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.