IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0082786.html
   My bibliography  Save this article

Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis

Author

Listed:
  • Anna H van’t Hoog
  • Frank Cobelens
  • Anna Vassall
  • Sanne van Kampen
  • Susan E Dorman
  • David Alland
  • Jerrold Ellner

Abstract

Background: High costs are a limitation to scaling up the Xpert MTB/RIF assay (Xpert) for the diagnosis of tuberculosis in resource-constrained settings. A triaging strategy in which a sensitive but not necessarily highly specific rapid test is used to select patients for Xpert may result in a more affordable diagnostic algorithm. To inform the selection and development of particular diagnostics as a triage test we explored combinations of sensitivity, specificity and cost at which a hypothetical triage test will improve affordability of the Xpert assay. Methods: In a decision analytical model parameterized for Uganda, India and South Africa, we compared a diagnostic algorithm in which a cohort of patients with presumptive TB received Xpert to a triage algorithm whereby only those with a positive triage test were tested by Xpert. Findings: A triage test with sensitivity equal to Xpert, 75% specificity, and costs of US$5 per patient tested reduced total diagnostic costs by 42% in the Uganda setting, and by 34% and 39% respectively in the India and South Africa settings. When exploring triage algorithms with lower sensitivity, the use of an example triage test with 95% sensitivity relative to Xpert, 75% specificity and test costs $5 resulted in similar cost reduction, and was cost-effective by the WHO willingness-to-pay threshold compared to Xpert for all in Uganda, but not in India and South Africa. The gain in affordability of the examined triage algorithms increased with decreasing prevalence of tuberculosis among the cohort. Conclusions: A triage test strategy could potentially improve the affordability of Xpert for TB diagnosis, particularly in low-income countries and with enhanced case-finding. Tests and markers with lower accuracy than desired of a diagnostic test may fall within the ranges of sensitivity, specificity and cost required for triage tests and be developed as such.

Suggested Citation

  • Anna H van’t Hoog & Frank Cobelens & Anna Vassall & Sanne van Kampen & Susan E Dorman & David Alland & Jerrold Ellner, 2013. "Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-11, December.
    • Handle: RePEc:plo:pone00:0082786
    DOI: 10.1371/journal.pone.0082786
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0082786
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0082786&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0082786?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Samuel Shillcutt & Damian Walker & Catherine Goodman & Anne Mills, 2009. "Cost Effectiveness in Low- and Middle-Income Countries," PharmacoEconomics, Springer, vol. 27(11), pages 903-917, November.
    2. Bruce R Schackman & Christopher P Neukermans & Sandy N Nerette Fontain & Claudine Nolte & Patrice Joseph & Jean W Pape & Daniel W Fitzgerald, 2007. "Cost-Effectiveness of Rapid Syphilis Screening in Prenatal HIV Testing Programs in Haiti," PLOS Medicine, Public Library of Science, vol. 4(5), pages 1-11, May.
    3. Daphne I Ling & Laura L Flores & Lee W Riley & Madhukar Pai, 2008. "Commercial Nucleic-Acid Amplification Tests for Diagnosis of Pulmonary Tuberculosis in Respiratory Specimens: Meta-Analysis and Meta-Regression," PLOS ONE, Public Library of Science, vol. 3(2), pages 1-11, February.
    4. Nicolas A Menzies & Ted Cohen & Hsien-Ho Lin & Megan Murray & Joshua A Salomon, 2012. "Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluation," PLOS Medicine, Public Library of Science, vol. 9(11), pages 1-17, November.
    5. Anna Vassall & Sanne van Kampen & Hojoon Sohn & Joy S Michael & K R John & Saskia den Boon & J Lucian Davis & Andrew Whitelaw & Mark P Nicol & Maria Tarcela Gler & Anar Khaliqov & Carlos Zamudio & Mar, 2011. "Rapid Diagnosis of Tuberculosis with the Xpert MTB/RIF Assay in High Burden Countries: A Cost-Effectiveness Analysis," PLOS Medicine, Public Library of Science, vol. 8(11), pages 1-14, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. T I Armina Padmasawitri & Gerardus W Frederix & Bachti Alisjahbana & Olaf Klungel & Anke M Hövels, 2018. "Disparities in model-based cost-effectiveness analyses of tuberculosis diagnosis: A systematic review," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-20, May.
    2. Swati Jha & Nazir Ismail & David Clark & James J Lewis & Shaheed Omar & Andries Dreyer & Violet Chihota & Gavin Churchyard & David W Dowdy, 2016. "Cost-Effectiveness of Automated Digital Microscopy for Diagnosis of Active Tuberculosis," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-11, June.
    3. Nicola Foster & Lucy Cunnama & Kerrigan McCarthy & Lebogang Ramma & Mariana Siapka & Edina Sinanovic & Gavin Churchyard & Katherine Fielding & Alison D Grant & Susan Cleary, 2021. "Strengthening health systems to improve the value of tuberculosis diagnostics in South Africa: A cost and cost-effectiveness analysis," PLOS ONE, Public Library of Science, vol. 16(5), pages 1-21, May.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Alice Zwerling & Richard G White & Anna Vassall & Ted Cohen & David W Dowdy & Rein M G J Houben, 2014. "Modeling of Novel Diagnostic Strategies for Active Tuberculosis – A Systematic Review: Current Practices and Recommendations," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-8, October.
    2. Anna Vassall & Lindsay Mangham‐Jefferies & Gabriela B. Gomez & Catherine Pitt & Nicola Foster, 2016. "Incorporating Demand and Supply Constraints into Economic Evaluations in Low‐Income and Middle‐Income Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 95-115, February.
    3. Sze-chuan Suen & Margaret L. Brandeau & Jeremy D. Goldhaber-Fiebert, 2018. "Optimal timing of drug sensitivity testing for patients on first-line tuberculosis treatment," Health Care Management Science, Springer, vol. 21(4), pages 632-646, December.
    4. Simon van der Pol & Paula Rojas Garcia & Maarten J. Postma & Fernando Antoñanzas Villar & Antoinette D. I. Asselt, 2021. "Economic Analyses of Respiratory Tract Infection Diagnostics: A Systematic Review," PharmacoEconomics, Springer, vol. 39(12), pages 1411-1427, December.
    5. Elisa Sicuri & Silke Fernandes & Eusebio Macete & Raquel González & Ghyslain Mombo-Ngoma & Achille Massougbodgi & Salim Abdulla & August Kuwawenaruwa & Abraham Katana & Meghna Desai & Michel Cot & Mic, 2015. "Economic Evaluation of an Alternative Drug to Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-23, April.
    6. Neily Zakiyah & Antoinette D I van Asselt & Frank Roijmans & Maarten J Postma, 2016. "Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-19, December.
    7. James Buchanan & Borislava Mihaylova & Alastair Gray & Nicholas White, 2010. "Cost-Effectiveness of Pre-Referral Antimalarial, Antibacterial, and Combined Rectal Formulations for Severe Febrile Illness," PLOS ONE, Public Library of Science, vol. 5(12), pages 1-12, December.
    8. Udayan Singh & Lisa M. Colosi, 2019. "Potable Reuse of Coalbed Methane-Produced Waters in Developing Country Contexts—Could the Benefits Outweigh the Costs to Facilitate Coal Transitions?," Energies, MDPI, vol. 13(1), pages 1-18, December.
    9. Elisa Sicuri & Azucena Bardají & Tacilta Nhampossa & Maria Maixenchs & Ariel Nhacolo & Delino Nhalungo & Pedro L Alonso & Clara Menéndez, 2010. "Cost-Effectiveness of Intermittent Preventive Treatment of Malaria in Pregnancy in Southern Mozambique," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-10, October.
    10. Standaert, Baudouin & Schecroun, Nadia & Ethgen, Olivier & Topachevskyi, Oleksandr & Morioka, Yoriko & Van Vlaenderen, Ilse, 2017. "Optimising the introduction of multiple childhood vaccines in Japan: A model proposing the introduction sequence achieving the highest health gains," Health Policy, Elsevier, vol. 121(12), pages 1303-1312.
    11. Shu Chen & Lei Guo & Zhan Wang & Wenhui Mao & Yanfeng Ge & Xiaohua Ying & Jing Fang & Qian Long & Qin Liu & Hao Xiang & Chenkai Wu & Chaowei Fu & Di Dong & Jiahui Zhang & Ju Sun & Lichun Tian & Limin , 2019. "Current situation and progress toward the 2030 health-related Sustainable Development Goals in China: A systematic analysis," PLOS Medicine, Public Library of Science, vol. 16(11), pages 1-33, November.
    12. Nadia Yakhelef & Martine Audibert & Gabriella Ferlazzo & Joseph Sitienei & Steve Wanjala & Francis Varaine & Maryline Bonnet & Helena Huerga, 2020. "Cost-effectiveness of diagnostic algorithms including lateral-flow urine lipoarabinomannan for HIV-positive patients with symptoms of tuberculosis," Post-Print halshs-03170014, HAL.
    13. Gesine Meyer-Rath & Craig van Rensburg & Bruce Larson & Lise Jamieson & Sydney Rosen, 2017. "Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-9, October.
    14. Karuna D Sagili & Malaisamy Muniyandi & Kayzad Soli Nilgiriwala & Kalpita S Shringarpure & Srinath Satyanarayana & Richard Kirubakaran & Sarabjit S Chadha & Prathap Tharyan, 2018. "Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-16, October.
    15. James G Kahn & Aliya Jiwani & Gabriela B Gomez & Sarah J Hawkes & Harrell W Chesson & Nathalie Broutet & Mary L Kamb & Lori M Newman, 2014. "The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-10, January.
    16. Ivor Langley & Basra Doulla & Hsien-Ho Lin & Kerry Millington & Bertie Squire, 2012. "Modelling the impacts of new diagnostic tools for tuberculosis in developing countries to enhance policy decisions," Health Care Management Science, Springer, vol. 15(3), pages 239-253, September.
    17. Abdulaziz Ibrahim Alzarea & Yusra Habib Khan & Abdullah Salah Alanazi & Muhammad Hammad Butt & Ziyad Saeed Almalki & Abdullah K. AlAhmari & Saud Alsahali & Tauqeer Hussain Mallhi, 2022. "Barriers and Facilitators of Pharmacoeconomic Studies: A Review of Evidence from the Middle Eastern Countries," IJERPH, MDPI, vol. 19(13), pages 1-18, June.
    18. Stephanie Bogdewic & Rohit Ramaswamy & David M Goodman & Emmanuel K Srofenyoh & Sebnem Ucer & Medge D Owen, 2020. "The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-18, November.
    19. Natasha Howard & Lorna Guinness & Mark Rowland & Naeem Durrani & Kristian S Hansen, 2017. "Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 11(10), pages 1-18, October.
    20. Jennifer A Gilbert & Sheela V Shenoi & Anthony P Moll & Gerald H Friedland & A David Paltiel & Alison P Galvani, 2016. "Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-19, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0082786. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.