Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches
INTRODUCTION: In South Africa, Xpert® MTB/RIF Ultra (Ultra) is the recommended diagnostic assay for TB with line-probe assays for first- (LPAfl) and second-line drugs (LPAsl) providing additional drug susceptibility testing (DST) for samples that were rifampicin-resistant (RR-TB). To guide implement...
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International Union Against Tuberculosis and Lung Disease (The Union)
2024-05-01
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| Series: | IJTLD Open |
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| author | N. Cassim S.V. Omar S.D. Masuku H. Moultrie W.S. Stevens F. Ismail P. da Silva |
| author_facet | N. Cassim S.V. Omar S.D. Masuku H. Moultrie W.S. Stevens F. Ismail P. da Silva |
| author_sort | N. Cassim |
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| description | INTRODUCTION: In South Africa, Xpert® MTB/RIF Ultra (Ultra) is the recommended diagnostic assay for TB with line-probe assays for first- (LPAfl) and second-line drugs (LPAsl) providing additional drug susceptibility testing (DST) for samples that were rifampicin-resistant (RR-TB). To guide implementation of the recently launched Xpert® MTB/XDR (MTB/XDR) assay, a cost-outcomes analysis was conducted comparing total costs for genotypic DST (gDST) for persons diagnosed with RR-TB considering three strategies: replacing LPAfl/LPAsl (centralised level) with MTB/XDR vs. Ultra reflex testing (decentralised level). Further, DST was performed using residual specimen following RR-TB diagnosis. METHODS: The total cost of gDST was determined for three strategies, considering loss to follow-up (LTFU), unsuccessful test rates, and specimen volume. RESULTS: For 2019, 9,415 persons were diagnosed with RR-TB. A 35% LTFU rate between RR-TB diagnosis and LPAfl/LPAsl-DST was estimated. Unsuccessful test rates of 37% and 23.3% were reported for LPAfl and LPAsl, respectively. The estimated total costs were $191,472 for the conventional strategy, $122,352 for the centralised strategy, and $126,838 for the decentralised strategy. However, it was found that sufficient residual volume for reflex MTB/XDR testing is a limiting factor at the decentralised level. CONCLUSION: Centralising the implementation of XDR testing, as compared to LPAfl/LPAsl, leads to significant cost savings. |
| format | Article |
| id | doaj-art-906b2147672b4de997c534721a581a31 |
| institution | Kabale University |
| issn | 3005-7590 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | International Union Against Tuberculosis and Lung Disease (The Union) |
| record_format | Article |
| series | IJTLD Open |
| spelling | doaj-art-906b2147672b4de997c534721a581a312025-01-21T10:40:46ZengInternational Union Against Tuberculosis and Lung Disease (The Union)IJTLD Open3005-75902024-05-011521522210.5588/ijtldopen.23.05014Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approachesN. Cassim0S.V. Omar1S.D. Masuku2H. Moultrie3W.S. Stevens4F. Ismail5P. da Silva6National Priority Programme, National Health Laboratory Service, Johannesburg,Centre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaCentre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg,National Priority Programme, National Health Laboratory Service, Johannesburg,Centre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg,National Priority Programme, National Health Laboratory Service, Johannesburg,INTRODUCTION: In South Africa, Xpert® MTB/RIF Ultra (Ultra) is the recommended diagnostic assay for TB with line-probe assays for first- (LPAfl) and second-line drugs (LPAsl) providing additional drug susceptibility testing (DST) for samples that were rifampicin-resistant (RR-TB). To guide implementation of the recently launched Xpert® MTB/XDR (MTB/XDR) assay, a cost-outcomes analysis was conducted comparing total costs for genotypic DST (gDST) for persons diagnosed with RR-TB considering three strategies: replacing LPAfl/LPAsl (centralised level) with MTB/XDR vs. Ultra reflex testing (decentralised level). Further, DST was performed using residual specimen following RR-TB diagnosis. METHODS: The total cost of gDST was determined for three strategies, considering loss to follow-up (LTFU), unsuccessful test rates, and specimen volume. RESULTS: For 2019, 9,415 persons were diagnosed with RR-TB. A 35% LTFU rate between RR-TB diagnosis and LPAfl/LPAsl-DST was estimated. Unsuccessful test rates of 37% and 23.3% were reported for LPAfl and LPAsl, respectively. The estimated total costs were $191,472 for the conventional strategy, $122,352 for the centralised strategy, and $126,838 for the decentralised strategy. However, it was found that sufficient residual volume for reflex MTB/XDR testing is a limiting factor at the decentralised level. CONCLUSION: Centralising the implementation of XDR testing, as compared to LPAfl/LPAsl, leads to significant cost savings.https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000005/art00004drug susceptibility testingrifampicin-resistant tuberculosismultidrug-resistant tuberculosisline-probe assay |
| spellingShingle | N. Cassim S.V. Omar S.D. Masuku H. Moultrie W.S. Stevens F. Ismail P. da Silva Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches IJTLD Open drug susceptibility testing rifampicin-resistant tuberculosis multidrug-resistant tuberculosis line-probe assay |
| title | Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches |
| title_full | Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches |
| title_fullStr | Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches |
| title_full_unstemmed | Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches |
| title_short | Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches |
| title_sort | xpert mtb xdr implementation in south africa cost outcomes of centralised vs decentralised approaches |
| topic | drug susceptibility testing rifampicin-resistant tuberculosis multidrug-resistant tuberculosis line-probe assay |
| url | https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000005/art00004 |
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