Cost-effectiveness of Xpert MTB/RIF and investing in health care in Africa
CITATION: Dheda, K., Theron, G. & Welte, A. 2014. Cost-effectiveness of Xpert MTB/RIF and investing in health care in Africa. Lancet Global Health, 2(10):e554–e556, doi:10.1016/S2214-109X(14)70305-5.
The original publication is available at http://www.thelancet.com/journals/langlo
The Xpert MTB/RIF assay is an accurate test for the diagnosis of tuberculosis when an adequate sputum sample can be obtained; even in smear-negative tuberculosis the sensitivity is about 67%.1, 2 Although the assay turnaround time is under 2 h, depending on the health-care setting, time to tuberculosis treatment can be 2 weeks or more in a substantial number of patients.3 The technology has now been endorsed by WHO as a frontline test for tuberculosis in populations where there is a high incidence of HIV.4 Indeed, several countries in Africa are rolling out Xpert MTB/RIF.5 However, for expanded and sustained uptake, governments and policy makers require information about the cost-effectiveness of the technology to allow for appropriate planning and allocation of health-care resources. Cost-effectiveness must be balanced against affordability and sustainability. Thus, although the diagnostic accuracy of the technique is not in doubt, questions remain about the cost-effectiveness of the technology given that the overall number of patients treated for tuberculosis can remain unchanged6 and given the high rates of empirical treatment in resource-poor health-care settings.7