TY - JOUR T1 - Cost–benefit analysis of Xpert MTB/RIF for tuberculosis suspects in German hospitals JF - European Respiratory Journal JO - Eur Respir J SP - 575 LP - 587 DO - 10.1183/13993003.01333-2015 VL - 47 IS - 2 AU - Roland Diel AU - Albert Nienhaus AU - Doris Hillemann AU - Elvira Richter Y1 - 2016/02/01 UR - http://erj.ersjournals.com/content/47/2/575.abstract N2 - Our objective was to assess the cost–benefit of enhancing or replacing the conventional sputum smear with the real-time PCR Xpert MTB/RIF method in the inpatient diagnostic schema for tuberculosis (TB).Recent data from published per-case cost studies for TB/multidrug-resistant (MDR)-TB and from comparative analyses of sputum microscopy, mycobacterial culture, Xpert MTB/RIF and drug susceptibility testing, performed at the German National Reference Center for Mycobacteria, were used. Potential cost savings of Xpert MTB/RIF, based on test accuracy and multiple cost drivers, were calculated for diagnosing TB/MDR-TB suspects from the hospital perspective.Implementing Xpert MTB/RIF as an add-on in smear-positive and smear-negative TB suspects saves on average €48.72 and €503, respectively, per admitted patient as compared with the conventional approach. In smear-positive and smear-negative MDR-TB suspects, cost savings amount to €189.56 and €515.25 per person, respectively. Full replacement of microscopy by Xpert MTB/RIF saves €449.98. In probabilistic Monte-Carlo simulation, adding Xpert MTB/RIF is less costly in 46.4% and 76.2% of smear-positive TB and MDR-TB suspects, respectively, but 100% less expensive in all smear-negative suspects. Full replacement by Xpert MTB/RIF is also consistently cost-saving.Using Xpert MTB/RIF as an add-on to and even as a replacement for sputum smear examination may significantly reduce expenditures in TB suspects.Enhancing/replacing conventional sputum smear testing in TB with Xpert MTB/RIF may result in cost savings http://ow.ly/Stapk ER -