Table 3. Description of cost-effectiveness analyses reported in the included studies.
| Sr. No. | First Author, Year | Country | Economic Evaluation Type | Sample size (Test) | Sample size (ZN) | Model Type | Year Cost | Cost Indicator | Cost of Test | Cost of ZN | Effectiveness Indicator | Effectiveness-Test | Effectiveness-ZN | ICER | ICER Threshold | Sensitivity Analysis | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LED-FM vs ZN microscopy | |||||||||||||||||
| 1 | Whitelaw, 2011 | South Africa | CEA | 345 | 345 | NA | 2009–10 | Average cost per smear | 1.63 | 2.1 | Time per slide (min) | 1.8 | 2.5 | 0.67* | NR | NR | LED-FM microscopy is cheaper |
| 2 | Kelly, 2015 | India | CUA | 21,450 | 14,300 | Decision Tree | 2011–12 | Average cost per smear | 0.31 | 0.21 | DALYs | 27.45 | 40.84 | 14.64 | 1489 | One-way PA | LED-FM is cost effective at high load settings |
| 3 | Sohn, 2009 | Thailand | CEA | 30/day | 30/day | NA | 2007 | Average cost per smear | 1.03 | 1.16 | Time per slide (min) | 1 | 2.4 | 0.09* | NR | NR | LED-FM is cost-effective in resource limited settings |
| 4 | Xia, 2013 | China | CEA | 11,276 | 11,276 | NA | 2013 | Average cost per smear | 1.97 | 2.2 | Time per slide (min) | 2 | 3.4 | 0.16* | NR | NR | LED-FM is cost-effective in peripheral laboratories |
| GeneXpert vs ZN microscopy | |||||||||||||||||
| 5 | Mishra, 2012 | Zambia | CEA | NR | NR | Decision Tree | NM | Cost per case detected | 108.9 | 75.74 | TB cases averted | NR | NR | 252 | NR | NR | - |
| 6 | Pinto, 2016 | Brazil | CUA | NR | NR | Decision Tree | 2014 | Average cost per sample | 14.69 | 3.08 | Additional case diagnosed (%) | 3.9 | NR | 643 | 11,000 | Monte Carlo simulation | Single-sample GeneXpert testing can replace 2-sample sputum smear microscopy test |
| 7 | You, 2015 | Hongkong | CUA | NR | NR | Decision Tree | 2014 | Average cost per sample | 128 | 7.5 | QALYs | NR | NR | 99 | 50,000 | Monte Carlo simulation | Single sample GeneXpert testing during initial assessment of hospitalized patients is highly cost-effective |
| 8 | Jha, 2016 | South Africa | CEA | 1,009 | NR | Economic Model | 2015 | Average cost per sample | 14.45 | 1.59 | Additional case diagnosed | NR | NR | 1,927 | 2,000 | One-way PA | GeneXpert is likely to be highly cost-effective where the level of empiric TB diagnosis is low |
| 9 | Andrews, 2012 | South Africa | CUA | NR | NR | CEPAC | 2010 | Average cost per sample | 21.6 | 4.6 | Years of life saved (YLS) | NR | NR | 5,100 | 21,300 | Two-way PA | Two-sample GeneXpert testing is very cost-effective for screening all individuals initiating ART |
| 10 | Millman, 2013 | USA | CBA | 1,358 | 1,381 | Decision Tree | 2011 | Average cost per sample | 218 | 15 | Reduction in hospitalization | NR | NR | 101.5* | NR | Monte Carlo simulation | GeneXpert provides substantial savings to hospitals in high income countries by reducing overall length of stay |
| 11 | Menzies, 2012 | Botswana, Lesotho, Namibia, South Africa & Swaziland | CUA | 8,92,000 | 8,92,000 | Dynamic compartmental model | 2011 | Average cost per sample | 45 | 31 | DALYs | NR | NR | 959 | 1,000 | Monte Carlo simulation | GeneXpert has the potential to produce a substantial reduction in TB morbidity and mortality |
| 12 | Vassall, 2017 | South Africa | CUA | 2324 | 2332 | NA | 2012 | Average cost per participant | 168.79 | 160.64 | DALYs | NR | NR | 16.37 | NR | One-way PA | Xpert introduction in South Africa was cost-neutral |
| 13 | Tesfaye A, 2017 | Ethiopia | CUA | 54000 | 113000 | discrete-event simulation | 2014 | annualized cost per DALY averted | NR | NR | DALYs | NR | NR | 127 | 690 | One-way PA | Xpert is considered cost effective |
* ICER calculated; NA = Not Applicable; NR = Not Reported