ArticleThe Lancet. Global health2023
Multicomponent strategy with decentralised molecular testing for tuberculosis in Uganda: a cost and cost-effectiveness analysis.
Article in The Lancet. Global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Implementation strategies to increase the uptake and impact of molecular WHO-recommended rapid diagnostic tests: evidence from a mixed-methods systematic review.BMJ global health · 2025Pooled it
- An extended cost-effectiveness analysis of decentralised TB diagnostic testing with Molbio Truenat MTB/RIF versus hub-and-spoke GeneXpert MTB/RIF in Mozambique and Tanzania.BMJ global health · 2025Trial
- Cost and impact of decentralized tuberculosis testing: a modeling analysis of price thresholds for molecular instruments in high-burden settings.EClinicalMedicine · 2026Article
- Importance of confirmatory test characteristics in optimizing community-based screening for tuberculosis: an epidemiological modeling analysis.BMC infectious diseases · 2025Article
- Using sputum and tongue swab specimens for in-home point-of-care targeted universal testing for tuberculosis of household contacts: an acceptability and feasibility analysis.BMJ global health · 2025Article
- Decentralized TB diagnostic testing with Truenat MTB Plus and MTB-RIF Dx vs. hub-and-spoke GeneXpert MTB/RIF Ultra in Mozambique and Tanzania: a cost and cost-effectiveness analysis.PLOS global public health · 2025Article
- Impact of a multicomponent strategy including decentralized molecular testing for tuberculosis on mortality: planned analysis of a cluster-randomized trial in Uganda.EClinicalMedicine · 2024Article
- In-home TB Testing Using GeneXpert Edge is Acceptable, Feasible, and Improves the Proportion of Symptomatic Household Contacts Tested for TB: A Proof-of-Concept Study.Open forum infectious diseases · 2024Article
- Cost-effectiveness of diagnostic tools and strategies for the screening and diagnosis of tuberculosis disease and infection: a scoping review.BMJ public health · 2024Review
- Cost-effectiveness and budget impact of decentralising childhood tuberculosis diagnosis in six high tuberculosis incidence countries: a mathematical modelling study.EClinicalMedicine · 2024Article
- A Generalizable Decision-Making Framework for Selecting Onsite versus Send-out Clinical Laboratory Testing.Medical decision making : an international journal of the Society for Medical Decision Making · 2024Article
- Cost-effectiveness of Low-complexity Screening Tests in Community-based Case-finding for Tuberculosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Interventions and implementation considerations for reducing pre-treatment loss to follow-up in adults with pulmonary tuberculosis: A scoping review.F1000Research · 2024Article
- Transforming tuberculosis diagnosis.Nature microbiology · 2023Article
- Providing specimen transport through an online marketplace in the Northern region of Ghana.African journal of laboratory medicine · 2023Article
- The value of histopathology combined with CapitalBioFrontiers in medicine · 2023Article
- India is well placed to scale innovations in tuberculosis diagnostics.The Indian journal of medical researchArticle
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Authors and funding
16 authors at 7 institutions in 5 countries.
Funding
Abstract
backgroundDecentralised molecular testing for tuberculosis could reduce missed diagnoses and losses to follow-up in high-burden settings. The aim of this study was to evaluate the cost and cost-effectiveness of the Xpert Performance Evaluation for Linkage to Tuberculosis Care (XPEL-TB) study strategy, a multicomponent strategy including decentralised molecular testing for tuberculosis, in Uganda.
methodsWe conducted a costing and cost-effectiveness analysis nested in a pragmatic cluster-randomised trial of onsite (decentralised) versus hub-and-spoke (centralised) testing for tuberculosis with Xpert MTB/RIF Ultra (Xpert) in 20 community health centres in Uganda. We collected empirical data on the cost of the XPEL-TB strategy (decentralised Xpert testing, workflow redesign, and performance feedback) and routine tuberculosis testing (onsite smear microscopy with specimen transport for centralised Xpert testing) from the health system perspective. Time-and-motion studies were performed to estimate activity-based service costs. Cost-effectiveness was assessed as the incremental cost (2019 US$) per tuberculosis diagnosis and per 14-day treatment initiation.
findingsThe XPEL-TB study ran from Oct 22, 2018, to March 1, 2020. Effectiveness and cost-effectiveness outcomes were assessed from Dec 1, 2018, to Nov 30, 2019 and included 4867 women and 3139 men. On a per-test basis, the cost of decentralised ($20·46, range $17·85-25·72) and centralised ($18·20, range $16·58-24·25) Xpert testing was similar. However, decentralised testing resulted in more patients receiving appropriate Xpert testing, so the per-patient cost of decentralised testing was higher: $20·28 (range $17·68-25·48) versus $9·59 (range $7·62-14·34). The XPEL-TB strategy was estimated to cost $1332 (95% uncertainty range $763-5558) per incremental tuberculosis diagnosis and $687 ($501-1207) per incremental patient initiating tuberculosis treatment within 14 days. Cost-effectiveness was reduced in sites performing fewer than 150-250 tests annually.
interpretationThe XPEL-TB strategy facilitated higher rates of Xpert testing for tuberculosis at a similar per-test cost and modest incremental cost per tuberculosis diagnosis and treatment initiation. Decentralised Xpert testing, with appropriate implementation supports, should be scaled up to clinics with sufficient testing volume to support a single-module device.
fundingThe National Heart, Lung, and Blood Institute.
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