title: Cost-benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals.
abstract: Our objective was to assess the cost-benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects.
authors.affiliation: Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany roland.diel@epi.uni-kiel.de.
authors.forename: Roland
authors.initials: R
authors.lastname: Diel
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus
authors.affiliation: National Reference Center for Mycobacteria, Borstel, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Hillemann
authors.affiliation: National Reference Center for Mycobacteria, Borstel, Germany Labor Limbach, Heidelberg, Germany.
authors.forename: Elvira
authors.initials: E
authors.lastname: Richter
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics*; D003362:Cost-Benefit Analysis; D012321:DNA-Directed RNA Polymerases / Q000235:genetics*; D005060:Europe; D005858:Germany; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D008853:Microscopy; D018803:Models, Economic; D009169:Mycobacterium tuberculosis / Q000235:genetics*; D060888:Real-Time Polymerase Chain Reaction / Q000191:economics*; D012293:Rifampin; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
chemical_list: D001426:Bacterial Proteins; C505805:rpoB protein, Mycobacterium tuberculosis; D012321:DNA-Directed RNA Polymerases; D012293:Rifampin