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-effectiveness of...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e058388.full |
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| author | Peter J Dodd Nyashadzaishe Mafirakureva Rina Triasih Debebe Shaweno Jens Levy Eveline Klinkenberg Petra de Haas Ineke Spruijt Nastiti Kaswandani Ahmed Bedru Melaku Gebremichael Edine W Tiemersma |
| author_facet | Peter J Dodd Nyashadzaishe Mafirakureva Rina Triasih Debebe Shaweno Jens Levy Eveline Klinkenberg Petra de Haas Ineke Spruijt Nastiti Kaswandani Ahmed Bedru Melaku Gebremichael Edine W Tiemersma |
| author_sort | Peter J Dodd |
| collection | DOAJ |
| 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. |
| format | Article |
| id | doaj-art-49df7cf2e1f04e7db769c7a3d43e3e27 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
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| series | BMJ Open |
| spelling | doaj-art-49df7cf2e1f04e7db769c7a3d43e3e272025-01-30T23:40:15ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-058388Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysisPeter J Dodd0Nyashadzaishe Mafirakureva1Rina Triasih2Debebe Shaweno3Jens Levy4Eveline Klinkenberg5Petra de Haas6Ineke Spruijt7Nastiti Kaswandani8Ahmed Bedru9Melaku Gebremichael10Edine W Tiemersma11ScHARR, The University of Sheffield, Sheffield, UKScHARR, The University of Sheffield, Sheffield, UKDepartment of Paediatrics, Universitas Gadjah Mada Fakultas Kedokteran, Yogyakarta, IndonesiaScHARR, The University of Sheffield, Sheffield, UKTechnical Division, KNCV Tuberculosis Foundation, Den Haag, The NetherlandsIndependent consultant, Connect TB, Den Haag, The NetherlandsTechnical Division, KNCV Tuberculosis Foundation, Den Haag, The NetherlandsKNCV Tuberculosis Foundation, Den Haag, The NetherlandsPediatric Department, RSCM Hospital, University of Indonesia Faculty of Medicine, Jakarta, IndonesiaKNCV Tuberculosis Foundation, Addis Ababa, EthiopiaTechnical Division, KNCV Tuberculosis Foundation, Addis Ababa, EthiopiaTechnical Division, KNCV Tuberculosis Foundation, Den Haag, The NetherlandsObjectives 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.https://bmjopen.bmj.com/content/12/7/e058388.full |
| spellingShingle | Peter J Dodd Nyashadzaishe Mafirakureva Rina Triasih Debebe Shaweno Jens Levy Eveline Klinkenberg Petra de Haas Ineke Spruijt Nastiti Kaswandani Ahmed Bedru Melaku Gebremichael Edine W Tiemersma Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis BMJ Open |
| 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 |
| url | https://bmjopen.bmj.com/content/12/7/e058388.full |
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