Cost-effectiveness of TB diagnostic technologies in Ethiopia: a modelling study

Lelisa Fekadu Assebe; Andargachew Kumsa Erena; Lemmessa Fikadu; Bizuneh Alemu; Yirgalem Shibiru Baruda; Boshen Jiao

doi:10.1186/s12962-024-00544-1

Cost-effectiveness of TB diagnostic technologies in Ethiopia: a modelling study

Cost Eff Resour Alloc. 2024 May 21;22(1):43. doi: 10.1186/s12962-024-00544-1.

Authors

Lelisa Fekadu Assebe^{1

2}, Andargachew Kumsa Erena³, Lemmessa Fikadu⁴, Bizuneh Alemu⁵, Yirgalem Shibiru Baruda⁶, Boshen Jiao⁷

Affiliations

¹ Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway. lelfekadu1@gmail.com.
² Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. lelfekadu1@gmail.com.
³ Disease Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia.
⁴ Health system strengthening through Performance Based Financing Project, Cordaid, Bahir dar, Ethiopia.
⁵ Department of Health Promotion and disease prevention, Oromia Regional Health Bureau, Addis Ababa, Ethiopia.
⁶ Department of Global Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
⁷ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Abstract

Background: Tuberculosis (TB) is a major threat to public health, particularly in countries where the disease is highly prevalent, such as Ethiopia. Early diagnosis and treatment are the main components of TB prevention and control. Although the national TB guideline recommends the primary use of rapid TB diagnostics whenever feasible, there is limited evidence available that assess the efficiency of deploying various diagnostic tools in the country. Hence, this study aims to evaluate the cost-effectiveness of rapid TB/MDR-TB diagnostic tools in Ethiopia.

Methods: A hybrid Markov model for a hypothetical adult cohort of presumptive TB cases was constructed. The following TB diagnostic tools were evaluated: X-pert MTB/RIF, Truenat, chest X-ray screening followed by an X-pert MTB/RIF, TB-LAMP, and smear microscopy. Cost-effectiveness was determined based on incremental costs ($) per Disability-adjusted Life Years (DALY) averted, using a threshold of one times Gross Domestic Product (GDP) per capita ($856). Data on starting and transition probabilities, costs, and health state utilities were derived from secondary sources. The analysis is conducted from the health system perspective, and a probabilistic sensitivity analysis is performed.

Result: The incremental cost-effectiveness ratio for X-pert MTB/RIF, compared to the next best alternative, is $276 per DALY averted, making it a highly cost-effective diagnostic tool. Additionally, chest X-ray screening followed an X-pert MTB/RIF test is less cost-effective, with an ICER of $1666 per DALY averted. Introducing X-pert MTB/RIF testing would enhance TB detection and prevent 9600 DALYs in a cohort of 10,000 TB patients, with a total cost of $3,816,000.

Conclusion: The X-pert MTB/RIF test is the most cost-effective diagnostic tool compared to other alternatives. The use of this diagnostic tool improves the early detection and treatment of TB cases. Increased funding for this diagnostic tool will enhance access, reduce the TB detection gaps, and improve treatment outcomes.

Keywords: Cost-effectiveness; Ethiopia; Microscopy; Rapid TB diagnostics; Tuberculosis.

Grants and funding

813596/Trond Mohn Foundation and NORAD through BCEPS