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Expanding diagnostic testing for drug-resistant tuberculosis in high burden settings: a cost-effectiveness analysis
Marya Getchell1, John Pastor Ansah2, Dodge Lim3
1Duke-NUS Medical School, Program in Health Services and Systems Research, Singapore, Singapore. maya.getchell@gmail.com.
BMC Public Health
|November 5, 2025
Summary
GeneXpert XDR is a cost-effective tool for detecting drug-resistant tuberculosis (DR-TB) in high-burden countries. Targeted Next Generation Sequencing (tNGS) is less cost-effective for routine use but may benefit high-risk groups.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Economics
Background:
- Limited data exists on the implementation and cost-effectiveness of novel diagnostics like GeneXpert XDR and targeted Next Generation Sequencing (tNGS) for drug-resistant tuberculosis (DR-TB) detection in high TB-burden, low-resource settings.
- Evaluating these tools is crucial for optimizing TB control strategies in resource-limited environments.
Purpose of the Study:
- To determine the cost-effectiveness of different strategies employing GeneXpert XDR or tNGS for DR-TB detection.
- To compare these strategies within high TB-burden, low-resource settings, specifically the Philippines and Thailand.
Main Methods:
- A dynamic simulation model was developed and calibrated using World Health Organization (WHO) TB data from the Philippines and Thailand.
- Intervention scenarios for expanded drug-resistance diagnostic testing were simulated from 2025 to 2035.
- Cost-effectiveness was assessed from a health system perspective, utilizing country-specific TB diagnosis and treatment costs, and estimating health benefits via disability-adjusted life years (DALYs).
Main Results:
- Both GeneXpert XDR and tNGS implementation improved TB health outcomes.
- GeneXpert XDR strategies demonstrated greater cost-effectiveness compared to tNGS strategies.
- Testing all TB cases with GeneXpert XDR was found to be cost-effective in both countries, with lower cost-effectiveness but still viable for previously treated cases.
- tNGS was deemed cost-effective only at higher willingness-to-pay thresholds.
Conclusions:
- GeneXpert XDR is a cost-effective addition to DR-TB diagnostic testing in high TB-burden countries.
- tNGS is not currently cost-effective for routine DR-TB clinical testing but holds potential for specific high-risk populations and new TB treatment regimens.
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