Table 3. Costs (US$), outcomes and ICERs over three years (36 one-month cycles) in a cohort with an estimated TB prevalence of 13%.
| Status quo and five investment scenarios | TB service costs per symptomatic individual (US$) | Outcomes per symptomatic individual | ICERs: compared against the status quo | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| In cohort of 10 000, true TB treated (range) | Provider costs | Societal costs | DALYs and DALYs averted | Deaths and Deaths averted | Provider cost/ DALY averted (95% UI) | Societal cost/ DALY averted (95% UI) | Provider cost/ death averted (95% UI) | Societal cost/ death averted (95% UI) | |||||
| Total (95% UI) | Incr change from base (%) | Total (95% UI) | Incr % change (range) | Total DALYs (95% UI) | Incr DALYs averted % change (range) | Total deaths (95% UI) | Incr deaths averted % change (range) | (95% UI) | (95% UI) | (95% UI) | (95% UI) | ||
| Xpert (status quo) | 940 | 89.66 | --- | 169.94 | --- | 4.72 | --- | 0.133 | --- | --- | --- | --- | --- |
| (920; 960) | (87; 92) | (167; 173) | (4.6; 4.8) | (0.129; 0.136) | |||||||||
| Xpert plus reduction in initial LTFU (iLTFU) | 1010 | 92.42 | 2.76 | 178.19 | 8.25 | 4.56 | 0.16 | 0.128 | 0.005 | 17.42 | 51.86 | 601.40 | 1790.50 |
| (C and E) | (990; 1030) | (90; 95) | 3% | (175; 181) | 5% | (4.4; 4.7) | 3% | (0.125; 0.132) | 4% | (2.2; 117.6) | (18.5; 271.0) | (75.1; 3806.7) | (644; 8774) |
| Xpert plus treatment from negative (TfN) | 1140 | 110.78 | 21.12 | 256.36 | 86.42 | 4.04 | 0.68 | 0.115 | 0.018 | 31.40 | 128.45 | 1180.00 | 4826.60 |
| (A and E) | (1120; 1160) | (109; 113) | 24% | (253; 260) | 51% | (3.9; 4.1) | 14% | (0.112; 0.118) | 14% | (24.6; 40.5) | (107.2; 157.0) | (905.9; 1567.3) | (3939.0; 6079.2) |
| Xpert plus reduction in initial LTFU, and treatment from negative (iLTFU_TfN) | 1210 | 113.55 | 23.89 | 264.60 | 94.66 | 3.88 | 0.84 | 0.110 | 0.023 | 28.73 | 113.82 | 1061.70 | 4205.70 |
| (A, C and E) | (1190; 1230) | (111; 116) | 27% | (261; 268) | 56% | (3.8; 4.0) | 18% | (0.107; 0.113) | 17% | (23.5; 35.3) | (98.3; 133.3) | (853.3; 1333.3) | (3569.1; 5035.1) |
| Xpert plus improvements in the negative pathway (NP) | 1420 | 141.01 | 51.35 | 278.87 | 108.93 | 3.42 | 1.30 | 0.096 | 0.037 | 39.70 | 84.19 | 1387.70 | 2943.10 |
| (B, D and E) | (1390; 1450) | (139; 143) | 57% | (274; 284) | 64% | (3.3; 3.5) | 28% | (0.093; 0.099) | 28% | (35.2; 44.9) | (75.0; 94.8) | (1225.6; 1576.9) | (2608.4; 3334.0) |
| Xpert plus reduction in initial LTFU, and improvements in the negative pathway (iLTFU_NP) | 1480 | 142.99 | 53.33 | 285.97 | 116.03 | 3.28 | 1.44 | 0.092 | 0.041 | 37.02 | 80.55 | 1292.97 | 2813.00 |
| (B, C, D and E) | (1460; 1510) | (141; 145) | 59% | (281; 291) | 68% | (3.2; 3.4) | 31% | (0.089; 0.094) | 31% | (33.3; 41.3) | (72.8; 89.4) | (1155.8; 1449.9) | (2527.7; 3139.4) |
In the Table, Incr is the incremental change in costs or effectiveness from the base case. The base case in this analysis which represents the current status quo, Xpert as observed in the intervention arm of the XTEND study; dominant: less costly and more effective; dominated: more costly and less effective; The 95% uncertainty interval (UI) is shown in parentheses; ICER: Incremental cost-effectiveness ratio; DALYs: Disability Adjusted Life Years. In the scenario column, the capital letters refer to the decision points upon which the investment scenario acts, as shown in Fig 1.