Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis
Objectives The WHO currently recommends stool testing using GeneXpert MTB/Rif (Xpert) for the diagnosis of paediatric tuberculosis (TB). The simple one-step (SOS) stool method enables processing for Xpert testing at the primary healthcare (PHC) level. We modelled the impact and cost-effectivene...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022
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| Subjects: | |
| Online Access: | https://repository.ugm.ac.id/283861/1/249.pdf |
| _version_ | 1826050702344978432 |
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| author | Mafirakureva, Nyashadzaishe Klinkenberg, Eveline Spruijt, Ineke Levy, Jens Shaweno, Debebe De Haas, Petra Kaswandani, Nastiti Bedru, Ahmed Triasih, Rina Gebremichael, Melaku Dodd, Peter J. Tiemersma, Edine W. |
| author_facet | Mafirakureva, Nyashadzaishe Klinkenberg, Eveline Spruijt, Ineke Levy, Jens Shaweno, Debebe De Haas, Petra Kaswandani, Nastiti Bedru, Ahmed Triasih, Rina Gebremichael, Melaku Dodd, Peter J. Tiemersma, Edine W. |
| author_sort | Mafirakureva, Nyashadzaishe |
| collection | UGM |
| description | Objectives The WHO currently recommends stool testing
using GeneXpert MTB/Rif (Xpert) for the diagnosis of
paediatric tuberculosis (TB). The simple one-step (SOS)
stool method enables processing for Xpert testing at the
primary healthcare (PHC) level. We modelled the impact
and cost-effectiveness of implementing the SOS stool
method at PHC for the diagnosis of paediatric TB in
Ethiopia and Indonesia, compared with the standard of
care. setting All children (age <15 years) presenting with
presumptive TB at primary healthcare or hospital level in
Ethiopia and Indonesia. Primary outcome Cost- effectiveness estimated as incremental costs compared with incremental disability-adjusted life-years (DALYs) saved. Methods Decision tree modelling was used to represent pathways of patient care and referral. We based model parameters on ongoing studies and surveillance, systematic literature review, and expert opinion. We estimated costs using data available publicly and obtained through in- country expert consultations. Health outcomes were based on modelled mortality and discounted life-years lost. results The intervention increased the sensitivity of TB diagnosis by 19–25% in both countries leading to a 14–20% relative reduction in mortality. Under the intervention, fewer children seeking care at PHC were referred (or self-referred) to higher levels of care; the number of
children initiating anti-TB treatment (ATT) increased by
18–25%; and more children (85%) initiated ATT at PHC
level. Costs increased under the intervention compared
with a base case using smear microscopy in the standard
of care resulting in incremental cost-effectiveness ratios
of US$132 and US$94 per DALY averted in Ethiopia and
Indonesia, respectively. At a cost-effectiveness threshold
of 0.5×gross domestic product per capita, the projected
probability of the intervention being cost-effective in
Ethiopia and Indonesia was 87% and 96%, respectively.
The intervention remained cost-effective under sensitivity
analyses. Conclusions The addition of the SOS stool method to national algorithms for diagnosing TB in children is likely to be cost-effective in both Ethiopia and Indonesia. |
| first_indexed | 2024-03-14T00:08:46Z |
| format | Article |
| id | oai:generic.eprints.org:283861 |
| institution | Universiti Gadjah Mada |
| language | English |
| last_indexed | 2024-03-14T00:08:46Z |
| publishDate | 2022 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oai:generic.eprints.org:2838612023-11-23T04:17:11Z https://repository.ugm.ac.id/283861/ Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis Mafirakureva, Nyashadzaishe Klinkenberg, Eveline Spruijt, Ineke Levy, Jens Shaweno, Debebe De Haas, Petra Kaswandani, Nastiti Bedru, Ahmed Triasih, Rina Gebremichael, Melaku Dodd, Peter J. Tiemersma, Edine W. Paediatrics Objectives The WHO currently recommends stool testing using GeneXpert MTB/Rif (Xpert) for the diagnosis of paediatric tuberculosis (TB). The simple one-step (SOS) stool method enables processing for Xpert testing at the primary healthcare (PHC) level. We modelled the impact and cost-effectiveness of implementing the SOS stool method at PHC for the diagnosis of paediatric TB in Ethiopia and Indonesia, compared with the standard of care. setting All children (age <15 years) presenting with presumptive TB at primary healthcare or hospital level in Ethiopia and Indonesia. Primary outcome Cost- effectiveness estimated as incremental costs compared with incremental disability-adjusted life-years (DALYs) saved. Methods Decision tree modelling was used to represent pathways of patient care and referral. We based model parameters on ongoing studies and surveillance, systematic literature review, and expert opinion. We estimated costs using data available publicly and obtained through in- country expert consultations. Health outcomes were based on modelled mortality and discounted life-years lost. results The intervention increased the sensitivity of TB diagnosis by 19–25% in both countries leading to a 14–20% relative reduction in mortality. Under the intervention, fewer children seeking care at PHC were referred (or self-referred) to higher levels of care; the number of children initiating anti-TB treatment (ATT) increased by 18–25%; and more children (85%) initiated ATT at PHC level. Costs increased under the intervention compared with a base case using smear microscopy in the standard of care resulting in incremental cost-effectiveness ratios of US$132 and US$94 per DALY averted in Ethiopia and Indonesia, respectively. At a cost-effectiveness threshold of 0.5×gross domestic product per capita, the projected probability of the intervention being cost-effective in Ethiopia and Indonesia was 87% and 96%, respectively. The intervention remained cost-effective under sensitivity analyses. Conclusions The addition of the SOS stool method to national algorithms for diagnosing TB in children is likely to be cost-effective in both Ethiopia and Indonesia. BMJ Publishing Group 2022 Article PeerReviewed application/pdf en https://repository.ugm.ac.id/283861/1/249.pdf Mafirakureva, Nyashadzaishe and Klinkenberg, Eveline and Spruijt, Ineke and Levy, Jens and Shaweno, Debebe and De Haas, Petra and Kaswandani, Nastiti and Bedru, Ahmed and Triasih, Rina and Gebremichael, Melaku and Dodd, Peter J. and Tiemersma, Edine W. (2022) Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis. BMJ Open, 12 (7). e058388. ISSN 20446055 https://bmjopen.bmj.com/content/bmjopen/12/7/e058388.full.pdf 10.1136/bmjopen-2021-058388 |
| spellingShingle | Paediatrics Mafirakureva, Nyashadzaishe Klinkenberg, Eveline Spruijt, Ineke Levy, Jens Shaweno, Debebe De Haas, Petra Kaswandani, Nastiti Bedru, Ahmed Triasih, Rina Gebremichael, Melaku Dodd, Peter J. Tiemersma, Edine W. Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis |
| title | Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis |
| title_full | Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis |
| title_fullStr | Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis |
| title_full_unstemmed | Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis |
| title_short | Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis |
| title_sort | xpert ultra stool testing to diagnose tuberculosis in children in ethiopia and indonesia a model based cost effectiveness analysis |
| topic | Paediatrics |
| url | https://repository.ugm.ac.id/283861/1/249.pdf |
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