Modelled economic evaluation
The structure of the economic model has been adapted from the cost–utility analyses identified in the literature search (Choi et al. 2013; Hughes et al. 2012) to suit the local context. As clinical management in Australia differs depending on the clinical suspicion of TB, the model will be separated into patients with:
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a high clinical suspicion of TB (where treatment is initiated based on clinical suspicion)
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a low clinical suspicion of TB (where treatment decisions are initiated or delayed based on AFB ± NAAT results).
The benefit of NAAT in patients with high clinical suspicion of TB is to identify resistance mutations and initiate appropriate treatment for MDR earlier. In addition to earlier MDR treatment initiation, patients with low clinical suspicion of TB have additional benefits: NAAT may differentiate between TB and NTM infections (who would have been previously treated on the basis of the AFB results alone), and may reduce the delay in treating those with true TB who returned a negative AFB result (who would not have been treated without the availability of NAAT).
The model will take the form of a cost–utility analysis as this enables an assessment of NAAT in the context of the proposed benefits described above, in addition to quantifying the cost and outcome implications of false-positive and false-negative results (for the AFB microscopy ± NAAT alternatives).
A time horizon of 20 months was chosen, although this is longer than previously published cost–utility analyses, to capture all costs and outcomes associated with treatment for all patients, as treatment beyond 1 year is standard in patients with MDR-TB.
A summary of the structure of the economic model is presented in Table .
Table Summary of the economic evaluation
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