Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysisResearch in context
Summary: Background: Targeted next-generation sequencing (tNGS) is promising alternative to phenotypic drug susceptibility testing (pDST) for detecting drug-resistant tuberculosis (DRTB). This study explored the potential cost-effectiveness of tNGS for the diagnosis of DR-TB across 3 settings: Indi...
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Elsevier
2025-01-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024005820 |
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| author | Suvesh Shrestha Angelina Addae Cecily Miller Nazir Ismail Alice Zwerling |
| author_facet | Suvesh Shrestha Angelina Addae Cecily Miller Nazir Ismail Alice Zwerling |
| author_sort | Suvesh Shrestha |
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| description | Summary: Background: Targeted next-generation sequencing (tNGS) is promising alternative to phenotypic drug susceptibility testing (pDST) for detecting drug-resistant tuberculosis (DRTB). This study explored the potential cost-effectiveness of tNGS for the diagnosis of DR-TB across 3 settings: India, South Africa and Georgia. Methods: To inform WHO guideline development group (GDG) on tNGS we developed a stochastic decision analysis model and assessed cost-effectiveness of tNGS for DST among rifampicin resistance individuals. We also assessed tNGS as initial test for TB drug resistance in bacteriologically confirmed TB. Diagnostic accuracy and cost data were sourced from a systematic review conducted for GDG, covering studies published until September 2022. The primary outcome was incremental cost (2021 US$) per disability-adjusted life year (DALY) averted. Findings: tNGS when compared with in-country DST, tNGS proved cost-effective in South Africa (ICER: $15,619/DALY averted, WTP: $21,165) but not in Georgia (ICER: $18,375/DALY averted, WTP: $15,069). In India, tNGS dominated in-country DST practice, providing greater health impact at lower cost. When comparing tNGS with universal pDST, tNGS was dominated by pDST in all three countries. In Georgia, using tNGS as initial test for TB drug-resistance compared to Xpert MTB/Rif followed by pDST appeared cost-effective. Scenario with 50% reduction in tNGS test kit costs made tNGS cost-effective across all three countries, while a high Bedaquiline resistance prevalence (30%) led to a worsening cost-effectiveness. Interpretation: tNGS may be cost-effective in India, South Africa and Georgia when comprehensive DST is not routinely performed. Thus, existing DST practice and healthcare infrastructure should be considered before implementation and scale-up of tNGS. Funding: Global Tuberculosis Program, World Health Organization (2022/1249364-0). |
| format | Article |
| id | doaj-art-b4ef747938914af38ef7dcbf9e1fdbfa |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | EClinicalMedicine |
| spelling | doaj-art-b4ef747938914af38ef7dcbf9e1fdbfa2025-01-22T05:43:29ZengElsevierEClinicalMedicine2589-53702025-01-0179103003Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysisResearch in contextSuvesh Shrestha0Angelina Addae1Cecily Miller2Nazir Ismail3Alice Zwerling4School of Epidemiology and Public Health, University of Ottawa, Ottawa, CanadaSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, CanadaGlobal Tuberculosis Program, World Health Organization, Geneva, SwitzerlandGlobal Tuberculosis Program, World Health Organization, Geneva, Switzerland; Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, Wits University, Johannesburg, South AfricaSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Corresponding author.Summary: Background: Targeted next-generation sequencing (tNGS) is promising alternative to phenotypic drug susceptibility testing (pDST) for detecting drug-resistant tuberculosis (DRTB). This study explored the potential cost-effectiveness of tNGS for the diagnosis of DR-TB across 3 settings: India, South Africa and Georgia. Methods: To inform WHO guideline development group (GDG) on tNGS we developed a stochastic decision analysis model and assessed cost-effectiveness of tNGS for DST among rifampicin resistance individuals. We also assessed tNGS as initial test for TB drug resistance in bacteriologically confirmed TB. Diagnostic accuracy and cost data were sourced from a systematic review conducted for GDG, covering studies published until September 2022. The primary outcome was incremental cost (2021 US$) per disability-adjusted life year (DALY) averted. Findings: tNGS when compared with in-country DST, tNGS proved cost-effective in South Africa (ICER: $15,619/DALY averted, WTP: $21,165) but not in Georgia (ICER: $18,375/DALY averted, WTP: $15,069). In India, tNGS dominated in-country DST practice, providing greater health impact at lower cost. When comparing tNGS with universal pDST, tNGS was dominated by pDST in all three countries. In Georgia, using tNGS as initial test for TB drug-resistance compared to Xpert MTB/Rif followed by pDST appeared cost-effective. Scenario with 50% reduction in tNGS test kit costs made tNGS cost-effective across all three countries, while a high Bedaquiline resistance prevalence (30%) led to a worsening cost-effectiveness. Interpretation: tNGS may be cost-effective in India, South Africa and Georgia when comprehensive DST is not routinely performed. Thus, existing DST practice and healthcare infrastructure should be considered before implementation and scale-up of tNGS. Funding: Global Tuberculosis Program, World Health Organization (2022/1249364-0).http://www.sciencedirect.com/science/article/pii/S2589537024005820Targeted next-generation sequencing (tNGS)Drug-resistant tuberculosis (DRTB)Cost-effectiveness analysisIncremental cost-effectiveness ratio (ICER)Disability-adjusted life year (DALY) |
| spellingShingle | Suvesh Shrestha Angelina Addae Cecily Miller Nazir Ismail Alice Zwerling Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysisResearch in context EClinicalMedicine Targeted next-generation sequencing (tNGS) Drug-resistant tuberculosis (DRTB) Cost-effectiveness analysis Incremental cost-effectiveness ratio (ICER) Disability-adjusted life year (DALY) |
| title | Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysisResearch in context |
| title_full | Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysisResearch in context |
| title_fullStr | Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysisResearch in context |
| title_full_unstemmed | Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysisResearch in context |
| title_short | Cost-effectiveness of targeted next-generation sequencing (tNGS) for detection of tuberculosis drug resistance in India, South Africa and Georgia: a modeling analysisResearch in context |
| title_sort | cost effectiveness of targeted next generation sequencing tngs for detection of tuberculosis drug resistance in india south africa and georgia a modeling analysisresearch in context |
| topic | Targeted next-generation sequencing (tNGS) Drug-resistant tuberculosis (DRTB) Cost-effectiveness analysis Incremental cost-effectiveness ratio (ICER) Disability-adjusted life year (DALY) |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024005820 |
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