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Improving rifampicin resistant tuberculosis diagnosis with Xpert® MTB/RIF: modelling interventions and costs

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Dunbar, Rory, Naidoo, Pren, Beyers, Nulda and Langley, Ivor ORCID: https://orcid.org/0000-0002-9275-6731 (2018) 'Improving rifampicin resistant tuberculosis diagnosis with Xpert® MTB/RIF: modelling interventions and costs'. The International Journal of Tuberculosis and Lung Disease, Vol 22, Issue 8, pp. 890-898.

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Abstract

Setting
Cape Town, South Africa
Objective
To model RMP-R diagnosis and laboratory costs in smear/culture and Xpert-based algorithms and the effect of varying adherence and HIV testing in the Xpert-based algorithm.
Methods
We used a validated operational model (100,000 population) and published laboratory cost data. We estimated the number and cost of RMP-R TB cases identified between a smear/culture and Xpert-based algorithm. We modelled varying adherence and different levels of known HIV-status to the Xpert-based algorithm.
Results
RMP-R TB cases identified increased from 603 with smear/culture to 1,178 with the Xpert-based algorithm (100% adherence - 60% knew their HIV status). The overall laboratory cost increased from U$1,073,858 to U$2,430,050 and the cost per RMP-TB case identified increased from U$1,781 to U$2,063 in respective algorithms.
When adherence to the Xpert-based algorithm was increased from 50% to 100% (60% knew their HIV-status), the number of RMP-R TB cases identified increased from 721 to 1,178.
Conclusion
The Xpert-based algorithm is efficient in identifying RMP-R TB as the increase in costs is offset by the increase in the number of cases identified. Adherence to the Xpert-based algorithm is important to ensure all presumptive TB cases receive the benefit of simultaneous TB and RMP-R testing.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 268 Antitubercular agents. Antitubercular antibiotics
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
WF Respiratory System > Tuberculosis > WF 360 Drug therapy
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.5588/ijtld.17.0594
Depositing User: Kelly Smyth
Date Deposited: 12 Jul 2018 15:15
Last Modified: 01 Feb 2019 02:02
URI: http://archive.lstmed.ac.uk/id/eprint/8395

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