2000. Rapid, Point-of-care Diagnosis of Tuberculosis with Novel Truenat Assay: Cost-effectiveness and Budgetary Impact Analysis for India’s Public Sector
Session: Poster Abstract Session: Diagnostics: Bacteria and Mycobacteria
Saturday, October 6, 2018
Room: S Poster Hall

Background: Point-of-care (POC) tuberculosis (TB) diagnostics may dramatically improve TB outcomes. Truenat is a new, battery-powered RT-PCR device that rapidly detects TB and rifampin resistance. Due to its portability, it may be valuable in peripheral healthcare settings. We evaluated the cost-effectiveness of Truenat in peripheral labs (designated microscopy centres [DMCs]) and public healthcare facilities in India.

Methods: We used the CEPAC-International microsimulation model to compare 4 TB diagnostic strategies for adult, HIV-negative patients with suspected TB: 1) sputum smear microscopy in DMCs (SSM); 2) Xpert MTB/RIF in DMCs (Xpert); 3) Truenat in DMCs (Truenat DMC); and 4) Truenat in public healthcare facilities (Truenat POC). We projected life expectancy (LE), costs, incremental cost-effectiveness ratios (ICERs), and 5y budget impact of full scale-up. A strategy was cost-effective if its ICER was <US$990/year of life saved (YLS) (i.e., <50% of India annual per capita GDP). Model inputs included: TB prevalence, 20%; sensitivity for TB detection, 92% for Xpert and 89% for Truenat; costs per test, $12.70 for Xpert and $13.20 for Truenat; linkage to care after diagnosis, 84% for DMC-based tests and 95% for POC. We varied these parameters in sensitivity analyses.

Results: Compared to SSM, other strategies increased TB case detection by >6%; Truenat POC increased LE by ~0.3y with ICER $210/YLS (Table 1). Compared to Xpert, Truenat DMC decreased LE and cost, but Truenat POC improved LE by 0.05y and was cost-effective. In multi-way sensitivity analysis at 5y horizon, Truenat POC, at 89% diagnostic sensitivity and linkage to care >86%, was cost-effective and sometimes cost-saving compared to Xpert (Fig 1). The cost-effectiveness of Truenat, relative to Xpert, depended on the interplay of sensitivity and linkage to care. Public-sector implementation of Truenat POC increased healthcare expenditures by $360 million compared to full scale-up of Xpert (Fig 2). Treatment costs, not diagnostic test costs, accounted for most of the difference.

Conclusion: When used at the point of care, Truenat for TB diagnosis should improve linkage to care, increase LE, and be cost-effective compared with SSM or Xpert and, thus, should be more widely utilized in India.


David J. Lee, MPH1,2, Nagalingeswaran Kumarasamy, MBBS, PhD3, Stephen Resch, PhD, MPH4, Gomathi N. Sivaramakrishnan, PhD5, Kenneth Mayer, MD1,6,7, Srikanth Tripathy, MBBS, MD5, A. David Paltiel, PhD8, Kenneth Freedberg, MD, MSc1,2,9 and Krishna P. Reddy, MD1,2,10, (1)Harvard Medical School, Boston, MA, (2)Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, (3)Y.R. Gaitonde Centre for AIDS Research and Education, Voluntary Health Services, Chennai, India, (4)Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, (5)National Institute for Research in Tuberculosis, Chennai, India, (6)The Fenway Institute, Boston, MA, (7)Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, (8)Yale School of Public Health, New Haven, CT, (9)Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, (10)Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA

Disclosures:

D. J. Lee, None

N. Kumarasamy, None

S. Resch, None

G. N. Sivaramakrishnan, None

K. Mayer, None

S. Tripathy, None

A. D. Paltiel, None

K. Freedberg, None

K. P. Reddy, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.