Evidence map›Paper›PMID 28619229›Full record

Trial reportThe Lancet. Global health2017

Cost-effectiveness of Xpert MTB/RIF for tuberculosis diagnosis in South Africa: a real-world cost analysis and economic evaluation.

Anna Vassall, Mariana Siapka, Nicola Foster, Lucy Cunnama, Lebogang Ramma, Katherine Fielding, Kerrigan McCarthy, Gavin Churchyard, Alison Grant, Edina Sinanovic

Open access · goldAbstract readPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Lancet. Global health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 6 pooled it
6.0field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 6 syntheses or guidelines pooled it, 71 citations in OpenAlex.

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  20. Public Health Impact and Cost-Effectiveness of Screening for Active Tuberculosis Disease or Infection Among Children in South Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 2 countries.

Anna VassallTB Centre, London School of Hygiene & Tropical Medicine, London, UK; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: anna.vassall@lshtm.ac.uk.
Mariana SiapkaDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
Nicola FosterHealth Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Lucy CunnamaHealth Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Lebogang RammaHealth Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Katherine FieldingTB Centre, London School of Hygiene & Tropical Medicine, London, UK.
Kerrigan McCarthyAurum Institute, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Public Health, Surveillance and Response, National Institute for Communicable Disease of the National Health Laboratory Service, Johannesburg, South Africa.
Gavin ChurchyardTB Centre, London School of Hygiene & Tropical Medicine, London, UK; Aurum Institute, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Advancing Treatment and Care for TB/HIV, South African Medical Research Council, Johannesburg, South Africa.
Alison GrantTB Centre, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Edina SinanovicHealth Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
University of Cape Town · ZALondon School of Hygiene & Tropical Medicine · GBUniversity of the Witwatersrand · ZA

Funding

Medical Research Council MR/K012126/1
6 · The paper itself

Abstract

backgroundIn 2010 a new diagnostic test for tuberculosis, Xpert MTB/RIF, received a conditional programmatic recommendation from WHO. Several model-based economic evaluations predicted that Xpert would be cost-effective across sub-Saharan Africa. We investigated the cost-effectiveness of Xpert in the real world during national roll-out in South Africa.

methodsFor this real-world cost analysis and economic evaluation, we applied extensive primary cost and patient event data from the XTEND study, a pragmatic trial examining Xpert introduction for people investigated for tuberculosis in 40 primary health facilities (20 clusters) in South Africa enrolled between June 8, and Nov 16, 2012, to estimate the costs and cost per disability-adjusted life-year averted of introducing Xpert as the initial diagnostic test for tuberculosis, compared with sputum smear microscopy (the standard of care).

findingsThe mean total cost per study participant for tuberculosis investigation and treatment was US$312·58 (95% CI 252·46-372·70) in the Xpert group and $298·58 (246·35-350·82) in the microscopy group. The mean health service (provider) cost per study participant was $168·79 (149·16-188·42) for the Xpert group and $160·46 (143·24-177·68) for the microscopy group of the study. Considering uncertainty in both cost and effect using a wide range of willingness to pay thresholds, we found less than 3% probability that Xpert introduction improved the cost-effectiveness of tuberculosis diagnostics.

interpretationAfter analysing extensive primary data collection during roll-out, we found that Xpert introduction in South Africa was cost-neutral, but found no evidence that Xpert improved the cost-effectiveness of tuberculosis diagnosis. Our study highlights the importance of considering implementation constraints, when predicting and evaluating the cost-effectiveness of new tuberculosis diagnostics in South Africa.

fundingBill & Melinda Gates Foundation.

Indexed as

Cost-Benefit AnalysisDrug Resistance, BacterialFemaleHumansMaleQuality-Adjusted Life YearsSouth AfricaSputumTuberculosis

Identifiers

PMID28619229
PMCPMC5471605
OpenAlexW2625261400

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.