ArticleEClinicalMedicine2026
Cost and impact of decentralized tuberculosis testing: a modeling analysis of price thresholds for molecular instruments in high-burden settings.
Article in EClinicalMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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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.
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.
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Who cites it
2 citing papers in PubMed.
- Current Landscape of Molecular Diagnostic Tests and Emerging Tools for Tuberculosis and Drug Resistance.Diagnostics (Basel, Switzerland) · 2026Review
- In-home molecular testing of tongue swabs and sputum to inform household-level screening with diagnostic escalation strategies for tuberculosis contact investigation: a prospective cohort study in South Africa.medRxiv : the preprint server for health sciences · 2026Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Despite progress in reducing global tuberculosis (TB) incidence, ongoing funding disruptions threaten to reverse gains. Timely, accurate diagnosis integrated with rapid treatment is critical to reducing morbidity, mortality, and transmission-but remains costly, particularly for decentralized approaches. As global health budgets tighten, identifying the optimal cost for molecular TB diagnostics instruments is critical to inform scale-up decisions. Methods: We developed a probabilistic patient pathway model to assess the cost-effectiveness of decentralizing TB testing across primary healthcare facilities in high-burden settings. Scenarios varied by facility testing density (low, medium, high) and anticipated testing volume increases (none, partial, full). We included the effects of instrument downtime and calculated the maximum instrument + warranty prices at which fully decentralized testing would be considered cost-effective at a $500/disability-adjusted life year (DALY) averted threshold. Findings: Decentralization with increased testing averted up to 23% more DALYs than centralized testing but was not cost-effective at current instrument + warranty prices. Partial decentralization to the largest 20% of facilities approached cost-effectiveness (<$1000/DALY) with full testing increase. For full decentralization to meet the $500/DALY threshold, maximum viable instrument + warranty prices for low-throughput instruments ranged from $0 (no uptake increase) to $410-$6048 (increased testing uptake, low- to high-testing density settings). Interpretation: At current prices, decentralized molecular TB testing is unlikely to be cost-effective, even with improved uptake, systemwide. However, meaningful reductions in instrument + warranty costs could make both full and partial decentralization viable. As countries face tighter budgets, clear price targets for cost-effectiveness can help guide procurement and investment decisions in TB diagnostics. Funding: BMGF, Willem Bakhuys Roozenboomstichting.
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