title: A user-friendly, open-source tool to project impact and cost of diagnostic tests for tuberculosis.
abstract: Most models of infectious diseases, including tuberculosis (TB), do not provide results customized to local conditions. We created a dynamic transmission model to project TB incidence, TB mortality, multidrug-resistant (MDR) TB prevalence, and incremental costs over 5 years after scale-up of nine alternative diagnostic strategies. A corresponding web-based interface allows users to specify local costs and epidemiology. In settings with little capacity for up-front investment, same-day microscopy had the greatest impact on TB incidence and became cost-saving within 5 years if delivered at $10/test. With greater initial investment, population-level scale-up of Xpert MTB/RIF or microcolony-based culture often averted 10 times more TB cases than narrowly-targeted strategies, at minimal incremental long-term cost. Xpert for smear-positive TB had reasonable impact on MDR-TB incidence, but at substantial price and little impact on overall TB incidence and mortality. This user-friendly modeling framework improves decision-makers' ability to evaluate the local impact of TB diagnostic strategies.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.
authors.forename: David W
authors.initials: DW
authors.lastname: Dowdy
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Andrews
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dodd
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
mesh_terms: D000904:Antibiotics, Antitubercular / Q000191:economics*; D019295:Computational Biology / Q000379:methods*; D003657:Decision Making; D003955:Diagnostic Tests, Routine / Q000191:economics*; D015658:HIV Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D020407:Internet; D018803:Models, Economic; D009169:Mycobacterium tuberculosis; D011336:Probability; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000904:Antibiotics, Antitubercular
keywords: diagnostic techniques and procedures; economic models; epidemiology; global health; infectious disease transmission; none; tuberculosis