The impact and cost of scaling up GeneXpert MTB/RIF in South Africa.
OBJECTIVE
We estimated the incremental cost and impact on diagnosis and treatment uptake of national rollout of Xpert MTB/RIF technology (Xpert) for the diagnosis of pulmonary TB above the cost of current guidelines for the years 2011 to 2016 in South Africa.


METHODS
We parameterised a population-level decision model with data from national-level TB databases (n = 199,511) and implementation studies. The model follows cohorts of TB suspects from diagnosis to treatment under current diagnostic guidelines or an algorithm that includes Xpert. Assumptions include the number of TB suspects, symptom prevalence of 5.5%, annual suspect growth rate of 10%, and 2010 public-sector salaries and drug and service delivery costs. Xpert test costs are based on data from an in-country pilot evaluation and assumptions about when global volumes allowing cartridge discounts will be reached.


RESULTS
At full scale, Xpert will increase the number of TB cases diagnosed per year by 30%-37% and the number of MDR-TB cases diagnosed by 69%-71%. It will diagnose 81% of patients after the first visit, compared to 46% currently. The cost of TB diagnosis per suspect will increase by 55% to USD 60-61 and the cost of diagnosis and treatment per TB case treated by 8% to USD 797-873. The incremental capital cost of the Xpert scale-up will be USD 22 million and the incremental recurrent cost USD 287-316 million over six years.


CONCLUSIONS
Xpert will increase both the number of TB cases diagnosed and treated and the cost of TB diagnosis. These results do not include savings due to reduced transmission of TB as a result of earlier diagnosis and treatment initiation.
Health Economics and Epidemiology Research Office (HE2RO), Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. gesine@bu.edu
Gesine
G
Meyer-Rath
Kathryn
K
Schnippel
Lawrence
L
Long
William
W
MacLeod
Ian
I
Sanne
Wendy
W
Stevens
Sagie
S
Pillay
Yogan
Y
Pillay
Sydney
S
Rosen
D003955:Diagnostic Tests, Routine / Q000191:economics*; D024881:Drug Resistance, Bacterial; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification* / Q000472:pathogenicity; D012293:Rifampin / Q000494:pharmacology*; D013019:South Africa; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
D012293:Rifampin