Browsing by Author "Hailu, Alemayehu Desalegne"

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    Cost-effectiveness analysis of Gene Xpert test compared to smear microscopy test for diagnosis of suspected tuberculosis patients at health facilities in Arsi zone, Ethiopia.
    (Addis Abeba University, 2019-10) Kaso,, Abdene; Hailu, Alemayehu Desalegne
    Background: Tuberculosis remains a global public health problem. It mainly affects the poor and vulnerable populations. Therefore, there is a substantial global and country level effort to detect and treat tuberculosis cases. Early diagnosis of tuberculosis is one of the pillars of the tuberculosis control strategy. Smear microscopy testing is a routine test for the diagnosis of pulmonary tuberculosis in resource-constrained countries. However, the use of rapid molecular tests like Gene Xpert is increasing, and many countries are scaling up the use of Gene Xpert without a clear evaluation of the cost and cost-effectiveness of the technique. Objective: To evaluate the cost-effectiveness of Gene Xpert test compared to smear microscopy test for diagnosis of tuberculosis patients at health facilities in Arsi zone. Methods: We developed a decision-analytic model to evaluate the cost-effectiveness of Gene Xpert algorithms compared to smear microscopy for the diagnosis of tuberculosis. Costs were estimated from the health provider perspective in a one-year time frame. We applied an ingredients-based costing approach to identify, measure, and value the cost of the smear microscopy and Xpert algorithm. Effectiveness was measured as the proportion of cases detected for each of the diagnostic strategies. The cost-effectiveness ratio was calculated by dividing the change in cost and change in effectiveness. One-way and probabilistic sensitivity analysis was done by varying different inputs parameters. Result: The unit cost of Gene Xpert and smear microscopy methods was $12.92 and $3.1 per test respectively. The unit costs of Xpert and smear microscopy were mostly influenced by the cost of cartridge $10.67 (82.58%) and supplies $1.28 (41.29%). The mean cost of smear microscopy and Gene Xpert site was 3.3$ ($2.4-$4.96) and 12.96$ ($12.69-$13.22) respectively. The cost-effectiveness of the Gene Xpert method was $729.82 per proportion of TB cases detected. During one-way sensitivity analysis, TB prevalence was the most influential parameter on ICER (530.56 to 1401.13 per proportion of TB cases detected). Conclusion: The unit cost of Gene Xpert is high compared to smear microscopy diagnostic method. Our study found that using the Gene Xpert as a routine test is cost-effective compared to one or three times GDP per capita of Ethiopia and can be part of the routine diagnostic testing strategy. TB prevalence was the most influential parameter of the costeffectiveness of the Gene Xpert method.