Assessment of the patient, health system, and population effects of Xpert MTB/RIF and alternative diagnostics for tuberculosis in Tanzania: an integrated.

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Presentation transcript:

Assessment of the patient, health system, and population effects of Xpert MTB/RIF and alternative diagnostics for tuberculosis in Tanzania: an integrated modelling approach Ivor Langley, MSc, Dr Hsien-Ho Lin, MD, Saidi Egwaga, MD, Basra Doulla, MSc, Chu-Chang Ku, BS, Prof Megan Murray, MD, Ted Cohen, MD, Prof S Bertel Squire, MD The Lancet Global Health Volume 2, Issue 10, Pages e581-e591 (October 2014) DOI: 10.1016/S2214-109X(14)70291-8 Copyright © 2014 Langley et al. Open Access article distributed under the terms of CC BY-NC-SA Terms and Conditions

Figure 1 Summary patient pathways for three tuberculosis diagnostic processes (A) Sputum smear microscopy. (B) Xpert MTB/RIF replacing microscopy. (C) Xpert MTB/RIF in addition to microscopy. MDR=multidrug resistant. The Lancet Global Health 2014 2, e581-e591DOI: (10.1016/S2214-109X(14)70291-8) Copyright © 2014 Langley et al. Open Access article distributed under the terms of CC BY-NC-SA Terms and Conditions

Figure 2 Linkage between the operational and transmission component of the integrated model The Lancet Global Health 2014 2, e581-e591DOI: (10.1016/S2214-109X(14)70291-8) Copyright © 2014 Langley et al. Open Access article distributed under the terms of CC BY-NC-SA Terms and Conditions

Figure 3 Model calibration and projected effects of full rollout of Xpert MTB/RIF on tuberculosis incidence, prevalence, and mortality (A) Model calibration to the observed incidence of tuberculosis in Tanzania. Point estimates and 95% confidence intervals of estimated incidence of tuberculosis in Tanzania reported by WHO. The 1000 posterior simulations after calibrating the transmission component to the observed incidence and the mean of the 1000 posterior simulations are shown. Projected effect on tuberculosis incidence (B), prevalence (C), and mortality (D) comparing the baseline scenario (Ziehl-Neelsen microscopy) with the full rollout of Xpert MTB/RIF. The Lancet Global Health 2014 2, e581-e591DOI: (10.1016/S2214-109X(14)70291-8) Copyright © 2014 Langley et al. Open Access article distributed under the terms of CC BY-NC-SA Terms and Conditions

Figure 4 Sustainability versus cost-effectiveness (average cost-effectiveness ratio, ACER) versus disability-adjusted life-years (DALYs) averted The size of the circles shows the scale of benefits from each intervention measured in DALYs averted over 10 years relative to the base case of Ziehl-Neelsen microscopy. LED=light-emitting diode. The Lancet Global Health 2014 2, e581-e591DOI: (10.1016/S2214-109X(14)70291-8) Copyright © 2014 Langley et al. Open Access article distributed under the terms of CC BY-NC-SA Terms and Conditions