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dc.contributor.authorMenzies, Nicolas Alan
dc.contributor.authorCohen, Ted
dc.contributor.authorLin, Hsien-Ho
dc.contributor.authorMurray, Megan Blanche
dc.contributor.authorSalomon, Joshua A.
dc.date.accessioned2013-04-30T13:32:25Z
dc.date.issued2012
dc.identifier.citationMenzies, Nicolas A., Ted Cohen, Hsien-Ho Lin, Megan Murray, and 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 9(11): e1001347.en_US
dc.identifier.issn1549-1277en_US
dc.identifier.issn1549-1676en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10591705
dc.description.abstractBackground: The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World Health Organization recommends Xpert for initial diagnosis in individuals suspected of having multidrug-resistant TB (MDR-TB) or HIV-associated TB, and many countries are moving quickly toward adopting Xpert. As roll-out proceeds, it is essential to understand the potential health impact and cost-effectiveness of diagnostic strategies based on Xpert. Methods and findings: We evaluated potential health and economic consequences of implementing Xpert in five southern African countries—Botswana, Lesotho, Namibia, South Africa, and Swaziland—where drug resistance and TB-HIV coinfection are prevalent. Using a calibrated, dynamic mathematical model, we compared the status quo diagnostic algorithm, emphasizing sputum smear, against an algorithm incorporating Xpert for initial diagnosis. Results were projected over 10- and 20-y time periods starting from 2012. Compared to status quo, implementation of Xpert would avert 132,000 (95% CI: 55,000–284,000) TB cases and 182,000 (97,000–302,000) TB deaths in southern Africa over the 10 y following introduction, and would reduce prevalence by 28% (14%–40%) by 2022, with more modest reductions in incidence. Health system costs are projected to increase substantially with Xpert, by US$460 million (294–699 million) over 10 y. Antiretroviral therapy for HIV represents a substantial fraction of these additional costs, because of improved survival in TB/HIV-infected populations through better TB case-finding and treatment. Costs for treating MDR-TB are also expected to rise significantly with Xpert scale-up. Relative to status quo, Xpert has an estimated cost-effectiveness of US$959 (633–1,485) per disability-adjusted life-year averted over 10 y. Across countries, cost-effectiveness ratios ranged from US$792 (482–1,785) in Swaziland to US$1,257 (767–2,276) in Botswana. Assessing outcomes over a 10-y period focuses on the near-term consequences of Xpert adoption, but the cost-effectiveness results are conservative, with cost-effectiveness ratios assessed over a 20-y time horizon approximately 20% lower than the 10-y values. Conclusions: Introduction of Xpert could substantially change TB morbidity and mortality through improved case-finding and treatment, with more limited impact on long-term transmission dynamics. Despite extant uncertainty about TB natural history and intervention impact in southern Africa, adoption of Xpert evidently offers reasonable value for its cost, based on conventional benchmarks for cost-effectiveness. However, the additional financial burden would be substantial, including significant increases in costs for treating HIV and MDR-TB. Given the fundamental influence of HIV on TB dynamics and intervention costs, care should be taken when interpreting the results of this analysis outside of settings with high HIV prevalence. Please see later in the article for the Editors' Summaryen_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pmed.1001347en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502465/pdf/en_US
dash.licenseLAA
dc.subjectMedicineen_US
dc.subjectEpidemiologyen_US
dc.subjectInfectious Disease Epidemiologyen_US
dc.subjectGlobal Healthen_US
dc.subjectInfectious Diseasesen_US
dc.subjectBacterial Diseasesen_US
dc.subjectTuberculosisen_US
dc.subjectMulti-Drug-Resistant Tuberculosisen_US
dc.subjectSexually Transmitted Diseasesen_US
dc.subjectAIDSen_US
dc.subjectInfectious Disease Controlen_US
dc.subjectInfectious Disease Modelingen_US
dc.subjectNon-Clinical Medicineen_US
dc.subjectHealth Economicsen_US
dc.subjectCost Effectivenessen_US
dc.titlePopulation Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluationen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS Medicineen_US
dash.depositing.authorSalomon, Joshua A.
dc.date.available2013-04-30T13:32:25Z
dc.identifier.doi10.1371/journal.pmed.1001347*
dash.contributor.affiliatedMenzies, Nicolas
dash.contributor.affiliatedMurray, Megan
dash.contributor.affiliatedSalomon, Joshua
dc.identifier.orcid0000-0003-3929-5515


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