Xpert MTB/RIF for diagnosis of TB and drug-resistant TB: a cost and affordability analysis

Abstract

Xpert MTB/RIF is a rapid test to diagnose tuberculosis (TB) and rifampicin-resistant TB. Cost and affordability will influence its uptake.

We assessed the cost, globally and in 36 high-burden countries (HBCs), of two strategies for diagnosing TB and multidrug-resistant TB (MDR-TB): Xpert with follow-on diagnostics, and conventional diagnostics. Costs were compared with funding available for TB care and control, and donor investments in HIV prevention and care.

Using Xpert to diagnose MDR-TB would cost US$ 0.09 billion/year globally and be lower cost than conventional diagnostics globally and in all HBCs. Diagnosing TB in HIV-positive people using Xpert would also cost about US$ 0.10 billion/year and be lower cost than conventional diagnostics globally and in 33/36 HBCs. Testing everyone with TB signs and symptoms would cost almost US$ 0.47 billion/year globally, much more than conventional diagnostics. However, in European countries, Brazil and South Africa the cost would represent <10% of TB funding.

Introducing Xpert to diagnose MDR-TB and to diagnose TB in HIV-positive people is warranted in many countries. Using it to test everyone with TB signs and symptoms is affordable in several middle-income countries, but financial viability in low-income countries requires large increases in TB funding and/or further price reductions.