A systematic review of the costs of diagnosis for multidrug-resistant/extensively drug-resistant TB in different settings
METHODS: We systematically reviewed the published evidence on cost/cost-effectiveness of rapid MDR/pre-XDR-TB and other methods for XDR-TB testing up to September 2022. PRISMA guidelines were followed. Collected data were analysed using Stata v17 software. Cost data were reported in USD ($) and summarised by mean, standard deviation, and range. Country income level was defined according to the World Bank country classification. Three simplified scenarios were also used to explore testing implications, based on low, intermediate and high TB incidence.
RESULTS: Of 157 records, 25 studies were included with 24 reporting the cost of Xpert/RIF and two that evaluated the implementation of the MTBDRplus test. The total rapid test cost ranged from $12.41–$218, including $1.13–$74.60 for reagents/consumables and $0.40–$14.34 for equipment.
CONCLUSION: The cost of MDR/XDR-TB diagnostics is lower in low resource settings. However, the cost-effective implementation of MDR/XDR-TB diagnostic algorithms requires careful consideration of local resources to avoid missed identification and the use of inappropriate regimen.
Keywords: GenoType MTBDRplus; MDR-TB; XDR-TB rapid test; Xpert MTB/RIF; cost; diagnosis
Document Type: Research Article
Affiliations: 1: Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy 2: Emerging Bacterial Pathogens Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy 3: Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy 4: Department of Infectious Diseases, Galliera Hospital, Genoa, Italy 5: WHO Regional Office for the Eastern Mediterranean Region, Cairo, Egypt 6: Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK 7: Public Health Consulting Group, Lugano, Switzerland 8: Victorian Tuberculosis Program, Melbourne Health and Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia 9: Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada 10: Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil 11: National Institute for Tuberculosis, Lung Diseases and Thoracic Surgery, Catholic University Ruzomberok, Vyšné Hágy, Slovakia 12: Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese, Italy
Publication date: May 1, 2023
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