Cost-effectiveness of improvements in diagnosis and treatment accessibility for tuberculosis control in India
OBJECTIVE/DESIGN: We extended a microsimulation model of TB in India calibrated to demographic, epidemiologic, and care trends to evaluate 1) replacing DST with Xpert; 2) replacing microscopy and culture with Xpert to diagnose multidrug-resistant TB (MDR-TB) and non-MDR-TB; 3) implementing nationwide PPM; and combinations of (3) with (1) or (2).
RESULTS: PPM (assuming costs of $38/person) and Xpert improved health and increase costs relative to the status quo. PPM alone or with Xpert cost <1 gross domestic product/capita per quality-adjusted life-year gained relative to the next best intervention, and dominated Xpert interventions excluding PPM.
CONCLUSIONS: While both PPM and Xpert are promising tools for combatting TB in India, PPM should be prioritized over Xpert, as private sector engagement is more cost-effective than Xpert alone and, if sufficient resources are available, would substantially increase the value of Xpert if both interventions are implemented together.
Keywords: PPM; Xpert® MTB/RIF; simulation
Document Type: Research Article
Affiliations: 1: Department of Management Science and Engineering, Stanford University, Stanford, California, USA 2: Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, California, USA; Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA 3: Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
Publication date: 01 September 2015
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