ArticleBMC infectious diseases2023
Pooling sputum testing to diagnose tuberculosis using xpert MTB/RIF and xpert ultra: a cost-effectiveness analysis.
Article in BMC infectious diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 15 citations in OpenAlex.
- Community-based "X-ray+Xpert® MTB/RIF ultra pooling test" case-finding strategy among high-risk groups in rural areas: a prospective application study.Emerging microbes & infections · 2026Article
- Feasibility and acceptability of pooled sputum testing for tuberculosis: a multicountry qualitative study of the Start4All project.BMJ open · 2026Article
- Article
- A preliminary study on the clinical value of simultaneous amplification and testing for tuberculosis (SAT-TB) for early therapeutic monitoring in multidrug-resistant/rifampicin-resistant tuberculosis.BMC infectious diseases · 2025Article
- Diagnostic performance of Ziehl-Neelsen staining and Auramine-Rhodamine staining techniques in the detection of pulmonary and extrapulmonary tuberculosis.Revista peruana de medicina experimental y salud publica · 2025Article
- Expanding molecular diagnostic coverage for tuberculosis by combining computer-aided chest radiography and sputum specimen pooling: a modeling study from four high-burden countries.BMC global and public health · 2024Article
- The Role of GeneXpertTropical medicine and infectious disease · 2023Article
- Implementation of large-scale pooled testing to increase rapid molecular diagnostic test coverage for tuberculosis: a retrospective evaluation.Scientific reports · 2023Article
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 5 countries.
Funding
Abstract
backgroundThe World Health Organization (WHO) recommends the diagnosis of tuberculosis (TB) using molecular tests, such as Xpert MTB/RIF (MTB/RIF) or Xpert Ultra (Ultra). These tests are expensive and resource-consuming, and cost-effective approaches are needed for greater coverage.
methodsWe evaluated the cost-effectiveness of pooling sputum samples for TB testing by using a fixed amount of 1,000 MTB/RIF or Ultra cartridges. We used the number of people with TB detected as the indicator for cost-effectiveness. Cost-minimization analysis was conducted from the healthcare system perspective and included the costs to the healthcare system using pooled and individual testing.
resultsThere was no significant difference in the overall performance of the pooled testing using MTB/RIF or Ultra (sensitivity, 93.9% vs. 97.6%, specificity 98% vs. 97%, p-value > 0.1 for both). The mean unit cost across all studies to test one person was 34.10 international dollars for the individual testing and 21.95 international dollars for the pooled testing, resulting in a savings of 12.15 international dollars per test performed (35.6% decrease). The mean unit cost per bacteriologically confirmed TB case was 249.64 international dollars for the individual testing and 162.44 international dollars for the pooled testing (34.9% decrease). Cost-minimization analysis indicates savings are directly associated with the proportion of samples that are positive. If the TB prevalence is ≥ 30%, pooled testing is not cost-effective.
conclusionPooled sputum testing can be a cost-effective strategy for diagnosis of TB, resulting in significant resource savings. This approach could increase testing capacity and affordability in resource-limited settings and support increased testing towards achievement of WHO End TB strategy.
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