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 euro48.72 and euro503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to euro189.56 and euro515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves euro449.98. 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.
- Diel, R.
- Nienhaus, A.
- Hillemann, D.
- Richter, E.
Keywords
- Bacterial Proteins/*genetics
- Cost-Benefit Analysis
- DNA-Directed RNA Polymerases/*genetics
- Europe
- Germany
- *Hospital Costs
- *Hospitalization
- Humans
- Microscopy
- Models, Economic
- Mycobacterium tuberculosis/*genetics
- Real-Time Polymerase Chain Reaction/*economics
- Rifampin
- Sensitivity and Specificity
- Sputum/microbiology
- Tuberculosis/diagnosis
- Tuberculosis, Multidrug-Resistant/*diagnosis
- Tuberculosis, Pulmonary/*diagnosis
