Scaling up Xpert MTB/RIF technology: the costs of laboratory- vs. clinic-based roll-out in South Africa.
Scaling up Xpert MTB/RIF technology: the costs of laboratory- vs. clinic-based roll-out in South Africa.
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DOI：
10.1111/j.1365-3156.2012.03028.x
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发表时间：
2012-09
期刊：
影响因子：
--
通讯作者：
Rosen S
中科院分区：
文献类型：
--
作者：
Schnippel K;Meyer-Rath G;Long L;MacLeod W;Sanne I;Stevens WS;Rosen S
世界卫生组织建议使用Xpert MTB/RIF诊断肺结核（PTB），但很少有证据表明Xpert仪器在公共卫生系统中的最佳位置。我们使用南非最近的数据，比较了在结核病治疗点（所有初级诊所和医院）放置Xpert的成本与在分区实验室放置Xpert的成本。我们估计了Xpert在初级诊所试点和国家Xpert推广到涂片显微镜实验室的试点阶段的成本/检测; 223个实验室或3799个治疗点中每个实验室的预期未来数量;所需Xpert仪器的数量和成本以及2014年每个放置场景中使用Xpert进行PTB诊断的国家成本。2014年，南非将对260万结核病嫌疑人进行检测。实验室放置需要274台Xpert仪器，而治疗点放置需要4020台仪器。Xpert检测盒价格为14.00美元，实验室放置的成本/检测为26.54美元，治疗点放置的成本/检测为38.91美元。低检测量和大量的站点是导致治疗点成本较高的主要原因。Xpert在实验室的全国性部署将花费7100万美元/年;治疗点部署将花费1.07亿美元/年，高出51%。将Xpert技术用于治疗点比将仪器用于涂片显微镜实验室要昂贵得多。治疗点安置的增量效益，在更好的病人的结果，将必须同样大，以证明国家卫生预算的额外费用。
The World Health Organization recommends using Xpert MTB/RIF for diagnosis of pulmonary tuberculosis (PTB), but there is little evidence on the optimal placement of Xpert instruments in public health systems. We used recent South African data to compare the cost of placing Xpert at points of TB treatment (all primary clinics and hospitals) with the cost of placement at sub-district laboratories. We estimated Xpert’s cost/test in a primary clinic pilot and in the pilot phase of the national Xpert roll-out to smear microscopy laboratories; the expected future volumes for each of 223 laboratories or 3799 points of treatment; the number and cost of Xpert instruments required and the national cost of using Xpert for PTB diagnosis for each placement scenario in 2014. In 2014, South Africa will test 2.6 million TB suspects. Laboratory placement requires 274 Xpert instruments, while point-of-treatment placement requires 4020 instruments. With an Xpert cartridge price of $14.00, the cost/test is $26.54 for laboratory placement and $38.91 for point-of-treatment placement. Low test volumes and a high number of sites are the major contributors to higher point-of-treatment costs. National placement of Xpert at laboratories would cost $71 million/year; point-of-treatment placement would cost $107 million/year, 51% more. Placing Xpert technology at points of treatment is substantially more expensive than placing the instruments in smear microscopy laboratories. The incremental benefits of point-of-treatment placement, in terms of better patient outcomes, will have to be equally substantial to justify the additional cost to the national health budget.
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影响因子：
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作者：
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DOI：
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发表时间：
2010-09-09
期刊：
The New England journal of medicine
影响因子：
--
作者：
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