Patient, health system, & population effects of Xpert MTB/RIF and alternative diagnostics for TB in Tanzania [0078]

Langley, I., Lin, H.H., Egwaga, S., Doulla, B., Ku, C.C., Murray, M., Cohen, T. and Squire, S.B., 2014. Assessment of the patient, health system, and population effects of Xpert MTB/RIF and alternative diagnostics for tuberculosis in Tanzania: an integrated modelling approach. The Lancet Global Health, 2(10), pp.e581-e591.

  • New diagnostic methods and algorithms could address weaknesses in current diagnostic processes but may increase resource and funding demands.
  • Full rollout of Xpert (B1) offers the greatest patient-level benefits among diagnostic options.
  • Xpert reduces the mean number of patient visits for diagnosis by 1.2 (95% CrI 1.1–1.3).
  • Time to start treatment decreases by 6.6 days (95% CrI 5.9–7.3) with Xpert.
  • Diagnostic loss to follow-up reduces by 7% (95% CrI 6–9), increasing successful diagnosis and treatment completion by 18%.
  • At the health-system level, full Xpert scale-up reduces required sputum samples by 34% (441,000 vs. 730,000 annually).
  • Xpert requires only 45% of the laboratory staff time compared to the base case.
  • Full Xpert rollout has the greatest epidemiological impact on reducing tuberculosis prevalence, mortality, and incidence.
  • Over 10 years, Xpert is projected to prevent 17,000 (95% CrI 8,800–26,600) tuberculosis cases and 39,700 (95% CrI 27,600–53,000) deaths.
  • New diagnostics also improve survival rates of tuberculosis and HIV co-infected patients, increasing ART access.
  • Three cost-effective strategies in Tanzania:
    • Full Xpert MTB/RIF (B1) rollout at $169 per DALY averted.
    • Same-day LED fluorescence microscopy (A3) at $45 per DALY averted.
    • LED fluorescence microscopy (A2) at $29 per DALY averted.

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