Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTBRIF A Dynamic Simulation and Economic Evaluation 英文参考文献.docVIP
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Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTBRIF A Dynamic Simulation and Economic Evaluation 英文参考文献
PopulationHealthImpactandCost-Effectivenessof
TuberculosisDiagnosiswithXpertMTB/RIF:ADynamic
SimulationandEconomicEvaluation
NicolasA.Menzies1,2*,TedCohen3,4,Hsien-HoLin5,MeganMurray3,JoshuaA.Salomon1,6
1Center for Health Decision Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America, 2Institute for Technology Assessment,
MassachusettsGeneralHospital,Boston,Massachusetts,UnitedStatesofAmerica,3DepartmentofEpidemiology,HarvardSchoolofPublicHealth,Boston,Massachusetts,
UnitedStatesofAmerica,4DivisionofGlobalHealthEquity,BrighamandWomen’sHospital,Boston,Massachusetts,UnitedStatesofAmerica, 5GraduateInstituteof
Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan, 6Department of Global Health and Population, Harvard School of Public Health,
Boston,Massachusetts,UnitedStatesofAmerica
Abstract
Background: The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World
HealthOrganizationrecommendsXpertforinitialdiagnosisinindividualssuspectedofhavingmultidrug-resistantTB(MDR-
TB)orHIV-associatedTB,andmanycountriesaremovingquicklytowardadoptingXpert.Asroll-outproceeds,itisessential
tounderstandthepotentialhealthimpactandcost-effectivenessofdiagnosticstrategiesbasedonXpert.
MethodsandFindings:WeevaluatedpotentialhealthandeconomicconsequencesofimplementingXpertinfivesouthern
African countries—Botswana, Lesotho, Namibia, South Africa, and Swaziland—where drug resistance and TB-HIV
coinfection are prevalent. Using a calibrated, dynamic mathematical model, we compared the status quo diagnostic
algorithm,emphasizingsputumsmear,againstanalgorithmincorporatingXpertforinitialdiagnosis.Resultswereprojected
over10-and20-ytimeperiodsstartingfrom2012.Comparedtostatusquo,implementationofXpertwouldavert132,000
(95% CI: 55,000–284,000) TB cases and 182,000 (97,000–302,000) TB deaths in southern Africa over the 10y following
introduction,andwouldreduceprevalenceby28%(14%–40
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