title: Microscopic observation drug-susceptibility assay vs. Xpert®MTB/RIF for the diagnosis of tuberculosis in a rural African setting: a cost-utility analysis.
abstract: To compare the cost-utility of microscopic observation drug-susceptibility assay (MODS) and Xpert®MTB/RIF implementation for tuberculosis (TB) diagnosis in rural northern Mozambique.
  
  
  
  Stochastic transmission compartmental TB model from the healthcare provider perspective with parameter input from direct measurements, systematic literature reviews and expert opinion. MODS and Xpert®MTB/RIF were evaluated as replacement test of smear microscopy (SM) or as an add-on test after a negative SM. Costs were calculated in 2013 USD, effects in disability-adjusted life years (DALY). Willingness to pay threshold (WPT) was established at once the per capita Gross National Income of Mozambique.
  
  
  
  MODS as an add-on test to negative SM produced an incremental cost-effectiveness ratio (ICER) of 5647.89USD/DALY averted. MODS as a substitute for SM yielded an ICER of 5374.58USD/DALY averted. Xpert®MTB/RIF as an add-on test to negative SM yielded ICER of 345.71USD/DALY averted. Xpert®MTB/RIF as a substitute for SM obtained an ICER of 122.13USD/DALY averted. TB prevalence and risk of infection were the main factors impacting MODS and Xpert®MTB/RIF ICER in the one-way sensitivity analysis. In the probabilistic sensitivity analysis, Xpert®MTB/RIF was most likely to have an ICER below the WPT, whereas MODS was not.
  
  
  
  Our cost-utility analysis favours the implementation of Xpert®MTB/RIF as a replacement of SM for all TB suspects in this rural high TB/HIV prevalence African setting.
authors.affiliation: Department of Public Health, University of Barcelona, Barcelona, Spain.|SolidarMed Mozambique, Ancuabe, Mozambique.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Wikman-Jorgensen
authors.affiliation: SolidarMed Mozambique, Ancuabe, Mozambique.|Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain.
authors.forename: Jara
authors.initials: J
authors.lastname: Llenas-García
authors.affiliation: Department of Public Health, University of Barcelona, Barcelona, Spain.|Research Unit, Paediatrics Department, CAP Valldoreix, Mutua Terrassa Foundation, Mutua Terrassa University Hospital, Terrassa, Catalunya, Spain.
authors.forename: Tomàs M
authors.initials: TM
authors.lastname: Pérez-Porcuna
authors.affiliation: SolidarMed Switzerland, Luzern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Hobbins
authors.affiliation: SolidarMed Switzerland, Luzern, Switzerland.
authors.forename: Jochen
authors.initials: J
authors.lastname: Ehmer
authors.affiliation: Provincial Health Directorate, Operational Research Nucleus of Pemba, Pemba, Mozambique.
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Mussa
authors.affiliation: Department of Public Health, University of Barcelona, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ascaso
mesh_terms: D000904:Antibiotics, Antitubercular / Q000494:pharmacology; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004269:DNA, Bacterial / Q000032:analysis; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000191:economics; D008853:Microscopy; D025202:Molecular Diagnostic Techniques / Q000191:economics; D009073:Mozambique; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics / Q000254:growth & development; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012293:Rifampin / Q000494:pharmacology*; D012424:Rural Population; D012680:Sensitivity and Specificity; D013183:Sputum; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000904:Antibiotics, Antitubercular; D004269:DNA, Bacterial; D012293:Rifampin
keywords: 
  Mycobacterium tuberculosis
  ; Afrique subsaharienne; Diagnóstico; Sub-Saharan Africa; analyse coût-efficacité; análisis de Coste-Efectividad; cost-effectiveness analysis; diagnosis; diagnostic; África subsahariana