What are the economic considerations? Overview
A cost–utility analysis is presented to assess the cost-effectiveness of adding NAAT to AFB smear microscopy, and culture and sensitivity (C&S) testing in a population with clinical signs and symptoms of active TB. This is consistent with previously published economic evaluations of NAAT identified in the international literature. The economic model takes the form of a decision tree analysis, incorporating estimates of TB prevalence in the tested population, and AFB microscopy ± NAAT accuracy. The time horizon of the model is 20 months, chosen to capture all related costs and health outcomes in patients treated for TB ± MDR. Costs captured in the economic modelling include those of treatment, treating AEs, monitoring/management, hospitalisation and secondary transmissions. Outcomes were measured in quality-adjusted life years (QALYs), which were adjusted to capture disutility associated with treatment, and a further utility penalty was applied to account for decreased outcomes associated with active TB transmissions.
Four scenarios were considered in the economic analyses, based on the involvement of clinical judgment in initial treatment decisions (i.e. in determining the pre-test probability of TB). Various sensitivity analyses were also undertaken. The ICER of NAAT in the scenario thought to best reflect current practice (the ‘TB mixed scenario’) is $90,728/QALY. The incremental costs were observed to be driven largely by the cost of NAAT ($130). The ICER is most sensitive to decreases in the prevalence of TB in the tested population and in the specificity of NAAT, particularly in those with AFB-negative results and for rifampicin resistance.
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