Table 3.
Influence of test volume on cost-effectiveness estimates
| Screening with LED | Screening with Xpert | |||||
|---|---|---|---|---|---|---|
| Test Volume (tests/year) | 50 | 100 | 1000 | 50 | 100 | 1000 |
| Observed screening conditions: (prevalence of TB: 2.4%) | ||||||
| •Cost per person screenedincremental to std of care | $116 ($43 to $298) |
$78 (CS to $261) |
$45 (CS to $226) |
$343 ($302 to $516) |
$199 ($123–$371) |
$69 ($16 to $240) |
| •DALYs averted per person screened * | 0.064 (0.05 to 0.075) |
0.122 (0.10 to 0.138) |
||||
| ICER** ($ per DALY averted) | $1808 ($567 to $$6023) |
$1216 (CS to $5313) |
$699 (CS to $4782) |
$2809 ($2191 to $5039) |
$1615 ($898 to $3644) |
$564 ($113 to $2386) |
| ICER** (Reference standard is LED) | $2,205 ($507 to $2379) |
|||||
| Unfavorable to screening: (low prevalence of TB: 1%) | ||||||
| •Cost per person screened incremental to std of care | $112 ($29 to $287) |
$336 ($290 to $501) |
||||
| •DALYs averted per person screened * | 0.027 (0.022 to 0.028) |
0.051 (0.045 to 0.054) |
||||
| •ICER** ($ per DALY averted) | $4190 ($1036 to $12909) |
$6606 ($5398 to $11105) |
||||
| Favorable to screening: (high prevalence of TB: 6%) | ||||||
| •Cost per person screened incremental to std of care | $55 (CS to $229) |
$91 ($31 to $261) |
||||
| •DALYs averted per person screened incremental to std of care | 0.16 (0.095 to 0.226) |
0.305 (0.21 to 0.399) |
||||
| •ICER** ($ per DALY averted) | $347 (CS to $2416) |
$298 ($77 to $1241) |
||||
Uncertainty ranges calculated using probabilistic sensitivity analysis, monte-carlo simulations over 10,000 runs.
*
Incremenal to standard of care;
**
ICER: Incremental cost-effectiveness ratio: Cost ($) per DALY averted, calculated incremental to cost/DALY averted with standard of care unless otherwise noted. CS: Cost saving compared with reference arm