title: Cost-effectiveness of Xpert® MTB/RIF for diagnosing pulmonary tuberculosis in the United States.
abstract: METHODS
  Conventional approaches to tuberculosis (TB) diagnosis and resistance testing are slow. The Xpert® MTB/RIF assay is an emerging molecular diagnostic assay for rapid TB diagnosis, offering results within 2 hours. However, the cost-effectiveness of implementing Xpert in settings with low TB prevalence, such as the United States, is unknown.
  
  
  OBJECTIVE
  We evaluated the cost-effectiveness of incorporating Xpert into TB diagnostic algorithms in the United States compared to existing diagnostics.
  
  
  METHODS
  A decision-analysis model compared current TB diagnostic algorithms in the United States to algorithms incorporating Xpert. Primary outcomes were the costs and quality-adjusted life years (QALYs) accrued with each strategy; cost-effectiveness was represented using incremental cost-effectiveness ratios (ICER).
  
  
  RESULTS
  Xpert testing of a single sputum sample from TB suspects is expected to result in lower total health care costs per patient (US2673) compared to diagnostic algorithms using only sputum microscopy and culture (US2728) and improved health outcomes (6.32 QALYs gained per 1000 TB suspects). Compared to existing molecular assays, implementation of Xpert in the United States would be considered highly cost-effective (ICER US39992 per QALY gained).
  
  
  CONCLUSIONS
  TB diagnostic algorithms incorporating Xpert in the United States are highly cost-effective.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Choi
authors.forename: K
authors.initials: K
authors.lastname: Miele
authors.forename: D
authors.initials: D
authors.lastname: Dowdy
authors.forename: M
authors.initials: M
authors.lastname: Shah
mesh_terms: D000465:Algorithms; D001431:Bacteriological Techniques / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques / Q000191:economics / Q000379:methods; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000191:economics / Q000382:microbiology; D014481:United States
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