S-C Suen1, E Bendavid2, J D Goldhaber-Fiebert3. 1. Department of Management Science and Engineering, Stanford University, Stanford, California, USA. 2. Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, California, USA; Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA. 3. Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA.
Abstract
SETTING: Inaccurate diagnosis and inaccessibility of care undercut the effectiveness of high-quality anti-tuberculosis treatment and select for resistance. Rapid diagnostic systems, such as Xpert(®) MTB/RIF for tuberculosis (TB) diagnosis and drug susceptibility testing (DST), and programs that provide high-quality DOTS anti-tuberculosis treatment to patients in the unregulated private sector (public-private mix [PPM]), may help address these challenges, albeit at increased cost. OBJECTIVE/ DESIGN: We extended a microsimulation model of TB in India calibrated to demographic, epidemiologic, and care trends to evaluate 1) replacing DST with Xpert; 2) replacing microscopy and culture with Xpert to diagnose multidrug-resistant TB (MDR-TB) and non-MDR-TB; 3) implementing nationwide PPM; and combinations of (3) with (1) or (2). RESULTS: PPM (assuming costs of $38/person) and Xpert improved health and increase costs relative to the status quo. PPM alone or with Xpert cost <1 gross domestic product/capita per quality-adjusted life-year gained relative to the next best intervention, and dominated Xpert interventions excluding PPM. CONCLUSIONS: While both PPM and Xpert are promising tools for combatting TB in India, PPM should be prioritized over Xpert, as private sector engagement is more cost-effective than Xpert alone and, if sufficient resources are available, would substantially increase the value of Xpert if both interventions are implemented together.
SETTING: Inaccurate diagnosis and inaccessibility of care undercut the effectiveness of high-quality anti-tuberculosis treatment and select for resistance. Rapid diagnostic systems, such as Xpert(®) MTB/RIF for tuberculosis (TB) diagnosis and drug susceptibility testing (DST), and programs that provide high-quality DOTS anti-tuberculosis treatment to patients in the unregulated private sector (public-private mix [PPM]), may help address these challenges, albeit at increased cost. OBJECTIVE/ DESIGN: We extended a microsimulation model of TB in India calibrated to demographic, epidemiologic, and care trends to evaluate 1) replacing DST with Xpert; 2) replacing microscopy and culture with Xpert to diagnose multidrug-resistant TB (MDR-TB) and non-MDR-TB; 3) implementing nationwide PPM; and combinations of (3) with (1) or (2). RESULTS: PPM (assuming costs of $38/person) and Xpert improved health and increase costs relative to the status quo. PPM alone or with Xpert cost <1 gross domestic product/capita per quality-adjusted life-year gained relative to the next best intervention, and dominated Xpert interventions excluding PPM. CONCLUSIONS: While both PPM and Xpert are promising tools for combatting TB in India, PPM should be prioritized over Xpert, as private sector engagement is more cost-effective than Xpert alone and, if sufficient resources are available, would substantially increase the value of Xpert if both interventions are implemented together.
Authors: Carlos Acuna-Villaorduna; Anna Vassall; German Henostroza; Carlos Seas; Humberto Guerra; Lucy Vasquez; Nora Morcillo; Juan Saravia; Richard O'Brien; Mark D Perkins; Jane Cunningham; Luis Llanos-Zavalaga; Eduardo Gotuzzo Journal: Clin Infect Dis Date: 2008-08-15 Impact factor: 9.079
Authors: A Pantoja; K Lönnroth; S S Lal; L S Chauhan; M Uplekar; M R Padma; K P Unnikrishnan; J Rajesh; P Kumar; S Sahu; F Wares; K Floyd Journal: Int J Tuberc Lung Dis Date: 2009-06 Impact factor: 2.373
Authors: Joshua A Salomon; Theo Vos; Daniel R Hogan; Michael Gagnon; Mohsen Naghavi; Ali Mokdad; Nazma Begum; Razibuzzaman Shah; Muhammad Karyana; Soewarta Kosen; Mario Reyna Farje; Gilberto Moncada; Arup Dutta; Sunil Sazawal; Andrew Dyer; Jason Seiler; Victor Aboyans; Lesley Baker; Amanda Baxter; Emelia J Benjamin; Kavi Bhalla; Aref Bin Abdulhak; Fiona Blyth; Rupert Bourne; Tasanee Braithwaite; Peter Brooks; Traolach S Brugha; Claire Bryan-Hancock; Rachelle Buchbinder; Peter Burney; Bianca Calabria; Honglei Chen; Sumeet S Chugh; Rebecca Cooley; Michael H Criqui; Marita Cross; Kaustubh C Dabhadkar; Nabila Dahodwala; Adrian Davis; Louisa Degenhardt; Cesar Díaz-Torné; E Ray Dorsey; Tim Driscoll; Karen Edmond; Alexis Elbaz; Majid Ezzati; Valery Feigin; Cleusa P Ferri; Abraham D Flaxman; Louise Flood; Marlene Fransen; Kana Fuse; Belinda J Gabbe; Richard F Gillum; Juanita Haagsma; James E Harrison; Rasmus Havmoeller; Roderick J Hay; Abdullah Hel-Baqui; Hans W Hoek; Howard Hoffman; Emily Hogeland; Damian Hoy; Deborah Jarvis; Ganesan Karthikeyan; Lisa Marie Knowlton; Tim Lathlean; Janet L Leasher; Stephen S Lim; Steven E Lipshultz; Alan D Lopez; Rafael Lozano; Ronan Lyons; Reza Malekzadeh; Wagner Marcenes; Lyn March; David J Margolis; Neil McGill; John McGrath; George A Mensah; Ana-Claire Meyer; Catherine Michaud; Andrew Moran; Rintaro Mori; Michele E Murdoch; Luigi Naldi; Charles R Newton; Rosana Norman; Saad B Omer; Richard Osborne; Neil Pearce; Fernando Perez-Ruiz; Norberto Perico; Konrad Pesudovs; David Phillips; Farshad Pourmalek; Martin Prince; Jürgen T Rehm; Guiseppe Remuzzi; Kathryn Richardson; Robin Room; Sukanta Saha; Uchechukwu Sampson; Lidia Sanchez-Riera; Maria Segui-Gomez; Saeid Shahraz; Kenji Shibuya; David Singh; Karen Sliwa; Emma Smith; Isabelle Soerjomataram; Timothy Steiner; Wilma A Stolk; Lars Jacob Stovner; Christopher Sudfeld; Hugh R Taylor; Imad M Tleyjeh; Marieke J van der Werf; Wendy L Watson; David J Weatherall; Robert Weintraub; Marc G Weisskopf; Harvey Whiteford; James D Wilkinson; Anthony D Woolf; Zhi-Jie Zheng; Christopher J L Murray; Jost B Jonas Journal: Lancet Date: 2012-12-15 Impact factor: 79.321
Authors: Surendra K Sharma; Sanjeev Kumar; P K Saha; Ninoo George; S K Arora; Deepak Gupta; Urvashi Singh; M Hanif; R P Vashisht Journal: Indian J Med Res Date: 2011-03 Impact factor: 2.375
Authors: Henrik Salje; Jason R Andrews; Sarang Deo; Srinath Satyanarayana; Amanda Y Sun; Madhukar Pai; David W Dowdy Journal: PLoS Med Date: 2014-07-15 Impact factor: 11.069
Authors: Daniel E Winetsky; Diana M Negoescu; Emilia H DeMarchis; Olga Almukhamedova; Aizhan Dooronbekova; Dilshod Pulatov; Natalia Vezhnina; Douglas K Owens; Jeremy D Goldhaber-Fiebert Journal: PLoS Med Date: 2012-11-27 Impact factor: 11.069
Authors: Nicolas A Menzies; Gabriela B Gomez; Fiammetta Bozzani; Susmita Chatterjee; Nicola Foster; Ines Garcia Baena; Yoko V Laurence; Sun Qiang; Andrew Siroka; Sedona Sweeney; Stéphane Verguet; Nimalan Arinaminpathy; Andrew S Azman; Eran Bendavid; Stewart T Chang; Ted Cohen; Justin T Denholm; David W Dowdy; Philip A Eckhoff; Jeremy D Goldhaber-Fiebert; Andreas Handel; Grace H Huynh; Marek Lalli; Hsien-Ho Lin; Sandip Mandal; Emma S McBryde; Surabhi Pandey; Joshua A Salomon; Sze-Chuan Suen; Tom Sumner; James M Trauer; Bradley G Wagner; Christopher C Whalen; Chieh-Yin Wu; Delia Boccia; Vineet K Chadha; Salome Charalambous; Daniel P Chin; Gavin Churchyard; Colleen Daniels; Puneet Dewan; Lucica Ditiu; Jeffrey W Eaton; Alison D Grant; Piotr Hippner; Mehran Hosseini; David Mametja; Carel Pretorius; Yogan Pillay; Kiran Rade; Suvanand Sahu; Lixia Wang; Rein M G J Houben; Michael E Kimerling; Richard G White; Anna Vassall Journal: Lancet Glob Health Date: 2016-10-06 Impact factor: 26.763
Authors: T I Armina Padmasawitri; Gerardus W Frederix; Bachti Alisjahbana; Olaf Klungel; Anke M Hövels Journal: PLoS One Date: 2018-05-09 Impact factor: 3.240
Authors: Anna Maria Niewiadomska; Bamini Jayabalasingham; Jessica C Seidman; Lander Willem; Bryan Grenfell; David Spiro; Cecile Viboud Journal: BMC Med Date: 2019-04-24 Impact factor: 8.775
Authors: R M G J Houben; M Lalli; T Sumner; M Hamilton; D Pedrazzoli; F Bonsu; P Hippner; Y Pillay; M Kimerling; S Ahmedov; C Pretorius; R G White Journal: BMC Med Date: 2016-03-24 Impact factor: 8.775
Authors: Simon van der Pol; Paula Rojas Garcia; Maarten J Postma; Fernando Antoñanzas Villar; Antoinette D I van Asselt Journal: Pharmacoeconomics Date: 2021-07-15 Impact factor: 4.981