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.
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Date
2019-10
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Addis Abeba University
Abstract
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.
Description
I, the undersigned MPH student, declare that I have submitted my original work on a title
„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.
Keywords
Cost, Cost-effectiveness analysis, Gene-Xpert, Arsi zone