Cost-effectiveness of XPERT and Ultra-XPERT in active pulmonary tuberculosis in the Colombian pediatric population

Abstract

Background, the cost-effectiveness of Tuberculosis (TB) diagnosis remains challenging and poorly understood. TB remains a significant public health issue in Colombia due to its high transmissibility and lack of accessibility to health services for timely diagnosis and management, increasing mortality among vulnerable populations.

Objective: This study aims to identify rapid and cost-effective diagnostic techniques that assess the efficiency of Xpert MTB/RIF (Xpert) and Ultra (Xpert Ultra) compared with standard tests (smear)for tuberculosis in infantile pulmonary disease (pTB).

Methods: We developed a diagnostic cost-effectiveness model using a Monte Carlo simulation of 13.669 children with suspected pTB to estimate health effects and diagnostic and treatment costs. A systematic review was carried out for the effectiveness probabilities; from the provider's perspective, the cost was determined using the Delphi panel, Colombian guides and tariff manuals. Sensitivity and scenario analyses were performed to assess the robustness of the model and the validity of the results.

Results: The cost-effectiveness ratio (CER) in children under seven years of age for each positive case detected by bacilloscopy plus gastric aspirate culture cost 76.2 USD; for Xpert or Ultra Xpert 265.2 USD, and Xpert in bronchial lavage 526.5 USD; while for those over seven years of age it was 63.5 UDS and 249.5, respectively. The incremental cost-effectiveness ratio (ICER) was 9450 UDS for Xpert in both subgroups.