Cost-effectiveness of improvements in diagnosis and treatment accessibility for tuberculosis control in India

Int J Tuberc Lung Dis. 2015 Sep;19(9):1115-24, i-xv. doi: 10.5588/ijtld.15.0158.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Diagnostic Tests, Routine / economics*
  • Female
  • Humans
  • India
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Models, Theoretical
  • Mycobacterium tuberculosis / genetics
  • Public-Private Sector Partnerships / economics*
  • Quality-Adjusted Life Years
  • Sputum / microbiology*
  • Tuberculosis, Multidrug-Resistant / diagnosis*
  • Tuberculosis, Multidrug-Resistant / prevention & control
  • Tuberculosis, Pulmonary / diagnosis*
  • Tuberculosis, Pulmonary / prevention & control
  • Young Adult