title: Xpert MTB/RIF for diagnosis of tuberculosis and drug-resistant tuberculosis: a cost and affordability analysis.
abstract: Xpert MTB/RIF is a rapid test to diagnose tuberculosis (TB) and rifampicin-resistant TB. Cost and affordability will influence its uptake. We assessed the cost, globally and in 36 high-burden countries, of two strategies for diagnosing TB and multidrug-resistant (MDR)-TB: Xpert with follow-on diagnostics, and conventional diagnostics. Costs were compared with funding available for TB care and control, and donor investments in HIV prevention and care. Using Xpert to diagnose MDR-TB would cost US$70-90 million per year globally and be lower cost than conventional diagnostics globally and in all high-burden countries. Diagnosing TB in HIV-positive people using Xpert would also cost US$90-101 million per year and be lower cost than conventional diagnostics globally and in 33 out of 36 high-burden countries. Testing everyone with TB signs and symptoms would cost US$434-468 million per year globally, much more than conventional diagnostics. However, in European countries, Brazil and South Africa, the cost would represent <10% of TB funding. Introducing Xpert to diagnose MDR-TB and to diagnose TB in HIV-positive people is warranted in many countries. Using it to test everyone with TB signs and symptoms is affordable in several middle-income countries, but financial viability in low-income countries requires large increases in TB funding and/or further price reductions.
authors.affiliation: Global TB Programme, World Health Organization, Geneva, Switzerland. andreagpantoja@gmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Pantoja
authors.forename: Christopher
authors.initials: C
authors.lastname: Fitzpatrick
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
authors.forename: Karin
authors.initials: K
authors.lastname: Weyer
authors.forename: Katherine
authors.initials: K
authors.lastname: Floyd
mesh_terms: D003365:Costs and Cost Analysis; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D015658:HIV Infections / Q000150:complications; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000191:economics*; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D021141:Nucleic Acid Amplification Techniques / Q000191:economics; D012293:Rifampin; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
chemical_list: D012293:Rifampin