Cost-effectiveness analysis of Xpert in detecting Mycobacterium tuberculosis: A systematic review.

OBJECTIVES: To report the cost-effectiveness of Xpert in detecting Mycobacterium tuberculosis(MTB) through a comprehensive systematic review. METHODS: Specialized bibliographic databases were searched. Study quality was evaluated by commonly-used industry standards. Due to heterogeneity, evidences were synthesized narratively. RESULTS: Four studies from intermediate-to-low tuberculosis(TB)-burdern areas and 17 studies from high-TB-burden areas were included. Smear microscopy, clinical diagnosis and chest radiography were mostly used for comparison. Cost elements varied considerably depending on the perspectives.Cost-effectiveness and cost-utility analyses were used by seven and fourteen studies respectively. All studies were of high quality (CHEERS score of 78.4 and QHES score of 86.9).. Average cost per test was 29.8 US$ for Xpert compared with 3.83 US$ for smear microscopy. Cost-effectiveness analyses mostly supported application of Xpert into areas under varying TB burdens. CONCLUSIONS: Xpert seems cost-effective under respective willingness-to-pay thresholds in nations with differences in socioeconomy, HIV stress and geographical distribution.. Nevertheless, policymakers will benefit from localized studies since regional economic/financial statuses and health-care system should also be considered apart from the reports of cost-effectiveness.