Dataset Information

Informing decision-making for universal access to quality tuberculosis diagnosis in India: an economic-epidemiological model.

ABSTRACT:

Background

India and many other high-burden countries have committed to providing universal access to high-quality diagnosis and drug susceptibility testing (DST) for tuberculosis (TB), but the most cost-effective approach to achieve this goal remains uncertain. Centralized testing at district-level hub facilities with a supporting sample transport network can generate economies of scale, but decentralization to the peripheral level may provide faster diagnosis and reduce losses to follow-up (LTFU).

Methods

We generated functions to evaluate the costs of centralized and decentralized molecular testing for tuberculosis with Xpert MTB/RIF (Xpert), a WHO-endorsed test which can be performed at centralized and decentralized levels. We merged the cost estimates with an agent-based simulation of TB transmission in a hypothetical representative region in India to assess the impact and cost-effectiveness of each strategy.

Results

Compared against centralized Xpert testing, decentralization was most favorable when testing volume at decentralized facilities and pre-treatment LTFU were high, and specimen transport network was exclusively established for TB. Assuming equal quality of centralized and decentralized testing, decentralization was cost-saving, saving a median $338,000 (interquartile simulation range [IQR] -?$222,000; $889,000) per 20 million people over 10 years, in the most cost-favorable scenario. In the most cost-unfavorable scenario, decentralized testing would cost a median $3161 [IQR $2412; $4731] per disability-adjusted life year averted relative to centralized testing.

Conclusions

Decentralization of Xpert testing is likely to be cost-saving or cost-effective in most settings to which these simulation results might generalize. More decentralized testing is more cost-effective in settings with moderate-to-high peripheral testing volumes, high existing clinical LTFU, inability to share specimen transport costs with other disease entities, and ability to ensure high-quality peripheral Xpert testing. Decision-makers should assess these factors when deciding whether to decentralize molecular testing for tuberculosis.

SUBMITTER: Sohn H

PROVIDER: S-EPMC6683370 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Informing decision-making for universal access to quality tuberculosis diagnosis in India: an economic-epidemiological model.

Sohn Hojoon H Kasaie Parastu P Kendall Emily E Gomez Gabriela B GB Vassall Anna A Pai Madhukar M Dowdy David D

BMC medicine 20190806 1

<h4>Background</h4>India and many other high-burden countries have committed to providing universal access to high-quality diagnosis and drug susceptibility testing (DST) for tuberculosis (TB), but the most cost-effective approach to achieve this goal remains uncertain. Centralized testing at district-level hub facilities with a supporting sample transport network can generate economies of scale, but decentralization to the peripheral level may provide faster diagnosis and reduce losses to follo ...[more]

PMID: 31382959

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Dataset Information

Informing decision-making for universal access to quality tuberculosis diagnosis in India: an economic-epidemiological model.

Background

Methods

Results

Conclusions

Publications

Informing decision-making for universal access to quality tuberculosis diagnosis in India: an economic-epidemiological model.

Similar Datasets

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