Population health impact and cost-effectiveness of tuberculosis diagnosis with Xpert MTB/RIF

[TB0037]

Menzies, N.A., Cohen, T., Lin, H.H., Murray, M. and Salomon, J.A., 2012. Population health impact and cost-effectiveness of tuberculosis diagnosis with Xpert MTB/RIF: a dynamic simulation and economic evaluation. PLoS medicine, 9(11), p.e1001347.

·       TB diagnosis in high-burden settings mainly relies on sputum smear microscopy, which has limited sensitivity, especially among HIV-infected patients.

·       Traditional culture-based diagnosis and drug sensitivity testing are costly and slow, with many resource-limited settings lacking the capacity for high-volume testing.

·       The Xpert MTB/RIF automated DNA test provides rapid and sensitive detection of TB and rifampicin resistance, using a cartridge-based system that integrates sample processing and real-time PCR.

·       Xpert can be used by relatively unskilled healthcare workers and delivers results in less than 2 hours.

·       WHO recommended Xpert for initial diagnosis in suspected cases of multidrug-resistant TB (MDR-TB) or HIV-associated TB disease in December 2010.

·       Xpert has the potential to significantly reduce TB morbidity and mortality, especially in southern Africa, by diagnosing and enabling early treatment for smear-negative TB cases.

·       Over time, Xpert could reduce TB transmission and the reservoir of latent TB infection in the population.

·       Despite these benefits, TB incidence is projected to remain substantial after three decades of Xpert use without other changes to TB control strategies.

·       This persistence is due to the large pool of latently infected individuals and the lower transmission likelihood of smear-negative cases diagnosed by Xpert.

·       The adoption of Xpert increases demands on health systems, including the need for additional first-line TB treatment, HIV treatment for coinfected individuals, and second-line TB treatment for drug-resistant cases. 

[Yoseph Leonardo Samodra]

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