Figure 56 Results of the economic evaluation, AFB plus NAAT model arm
AFB = acid-fast bacilli test; C = culture; MDR = multidrug-resistant; NAAT = nucleic acid amplification test; R = resistance; RIF res = rifampicin-resistant; RIF suscept = rifampicin-susceptible; S = susceptibility; TB = tuberculosis
Additional scenarios TB low-suspicion scenario
Table 104 Outcome state probabilities, TB low scenario
True status
|
Treated status
|
AFB
|
AFB + NAAT
|
Difference
|
No TB
|
Untreated
|
76.4%
|
77.2%
|
0.75%
|
No TB
|
Standard treatment
|
1.6%
|
0.8%
|
–0.76%
|
No TB
|
MDR treatment
|
0.0%
|
0.0%
|
0.01%
|
TB
|
Untreated
|
9.5%
|
3.1%
|
–6.40%
|
TB
|
Standard treatment
|
12.1%
|
18.3%
|
6.21%
|
TB
|
MDR treatment
|
0.0%
|
0.2%
|
0.18%
|
MDR-TB
|
Untreated
|
0.2%
|
0.1%
|
–0.13%
|
MDR-TB
|
Standard treatment
|
0.2%
|
0.0%
|
–0.22%
|
MDR-TB
|
MDR treatment
|
0.0%
|
0.3%
|
0.35%
|
TOTAL
|
-
|
100%
|
100%
|
0%
|
Note: The probabilities associated with the correct treatment are highlighted.
AFB = acid-fast bacilli; MDR = multidrug-resistant; NAAT = nucleic acid amplification test; TB = tuberculosis
Table 105 Breakdown of incremental costs, TB low scenario
Cost
|
AFB
|
AFB + NAAT
|
Increment
|
Treatment
|
$556.06
|
$580.41
|
$24.36
|
Treatment of AEs
|
$3.02
|
$2.97
|
–$0.05
|
Management
|
$174.78
|
$172.86
|
–$1.92
|
Hospitalisation
|
$1,212.03
|
$1,176.62
|
–$35.40
|
TB transmissions
|
$159.54
|
$85.96
|
–$73.58
|
NAAT cost
|
$0.00
|
$130.00
|
$130.00
|
TOTAL
|
$2,105.43
|
$2,148.83
|
$43.39
|
AEs = adverse events; AFB = acid fast bacilli; NAAT = nucleic acid amplification test; TB = tuberculosis
Table 106 Weighted utility by outcome state, TB low scenario
True status
|
Treated status
|
AFB
|
AFB + NAAT
|
Increment
|
No TB
|
Untreated
|
1.075
|
1.085
|
0.011
|
No TB
|
Standard treatment
|
0.022
|
0.011
|
–0.011
|
No TB
|
MDR treatment
|
0.000
|
0.000
|
0.000
|
TB
|
Untreated
|
0.127
|
0.041
|
–0.085
|
TB
|
Standard treatment
|
0.165
|
0.250
|
0.085
|
TB
|
MDR treatment
|
0.000
|
0.002
|
0.002
|
MDR-TB
|
Untreated
|
0.002
|
0.001
|
–0.002
|
MDR-TB
|
Standard treatment
|
0.003
|
0.000
|
–0.003
|
MDR-TB
|
MDR treatment
|
0.000
|
0.004
|
0.004
|
TOTAL
|
-
|
1.394
|
1.396
|
0.002
|
Note: The outcomes associated with the correct treatment are highlighted.
AFB = acid-fast bacilli; MDR = multidrug-resistant; NAAT = nucleic acid amplification test; TB = tuberculosis
Perfect clinical judgement scenario
Table 107 Outcome state probabilities, perfect clinical judgement scenario
True status
|
Treated status
|
AFB
|
AFB + NAAT
|
Difference
|
No TB
|
Untreated
|
76.4%
|
77.2%
|
0.75%
|
No TB
|
Standard treatment
|
1.6%
|
0.8%
|
–0.76%
|
No TB
|
MDR treatment
|
0.0%
|
0.0%
|
0.01%
|
TB
|
Untreated
|
0.0%
|
0.0%
|
0.00%
|
TB
|
Standard treatment
|
21.6%
|
21.4%
|
–0.18%
|
TB
|
MDR treatment
|
0.0%
|
0.2%
|
0.18%
|
MDR-TB
|
Untreated
|
0.0%
|
0.0%
|
0.00%
|
MDR-TB
|
Standard treatment
|
0.4%
|
0.1%
|
–0.35%
|
MDR-TB
|
MDR treatment
|
0.0%
|
0.3%
|
0.35%
|
TOTAL
|
-
|
100%
|
100%
|
0%
|
Note: The probabilities associated with the correct treatment are highlighted.
AFB = acid-fast bacilli; MDR = multidrug-resistant; NAAT = nucleic acid amplification test; TB = tuberculosis
Table 108 Breakdown of incremental costs, perfect clinical judgement scenario
Cost
|
AFB
|
AFB + NAAT
|
Increment
|
Treatment
|
$557.70
|
$580.95
|
$23.25
|
Treatment of AEs
|
$3.05
|
$2.98
|
–$0.07
|
Management
|
$175.21
|
$173.00
|
–$2.21
|
Hospitalisation
|
$1,212.03
|
$1,176.62
|
–$35.40
|
TB transmissions
|
$68.22
|
$56.24
|
–$11.98
|
NAAT cost
|
$0.00
|
$130.00
|
$130.00
|
TOTAL
|
$2,016.20
|
$2,119.79
|
$103.59
|
AEs = adverse events; AFB = acid-fast bacilli; NAAT = nucleic acid amplification test; TB = tuberculosis
Table 109 Weighted utility by outcome state, perfect clinical judgement scenario
True status
|
Treated status
|
AFB
|
AFB + NAAT
|
Increment
|
No TB
|
Untreated
|
1.075
|
1.085
|
0.011
|
No TB
|
Standard treatment
|
0.022
|
0.011
|
–0.011
|
No TB
|
MDR treatment
|
0.000
|
0.000
|
0.000
|
TB
|
Untreated
|
0.000
|
0.000
|
0.000
|
TB
|
Standard treatment
|
0.295
|
0.293
|
–0.003
|
TB
|
MDR treatment
|
0.000
|
0.002
|
0.002
|
MDR-TB
|
Untreated
|
0.000
|
0.000
|
0.000
|
MDR-TB
|
Standard treatment
|
0.005
|
0.001
|
–0.004
|
MDR-TB
|
MDR treatment
|
0.000
|
0.004
|
0.004
|
TOTAL
|
-
|
1.397
|
1.397
|
0.0001
|
Note: the outcomes associated with the correct treatment are highlighted.
AFB = acid-fast bacilli; MDR = multidrug-resistant; NAAT = nucleic acid amplification test; TB = tuberculosis
TB high-suspicion scenario
Table 110 Outcome state probabilities, TB high scenario
True status
|
Treated status
|
AFB
|
AFB + NAAT
|
Difference
|
No TB
|
Untreated
|
0.0%
|
0.0%
|
0.00%
|
No TB
|
Standard treatment
|
78.0%
|
78.0%
|
–0.01%
|
No TB
|
MDR treatment
|
0.0%
|
0.0%
|
0.01%
|
TB
|
Untreated
|
0.0%
|
0.0%
|
0.00%
|
TB
|
Standard treatment
|
21.6%
|
21.4%
|
–0.18%
|
TB
|
MDR treatment
|
0.0%
|
0.2%
|
0.18%
|
MDR-TB
|
Untreated
|
0.0%
|
0.0%
|
0.00%
|
MDR-TB
|
Standard treatment
|
0.4%
|
0.1%
|
–0.35%
|
MDR-TB
|
MDR treatment
|
0.0%
|
0.3%
|
0.35%
|
TOTAL
|
-
|
100%
|
100%
|
0.00%
|
Note: The probabilities associated with the correct treatment are highlighted.
AFB = acid-fast bacilli; MDR = multidrug-resistant; NAAT = nucleic acid amplification test; TB = tuberculosis
Table 111 Breakdown of incremental costs, TB high scenario
Cost
|
AFB
|
AFB + NAAT
|
Increment
|
Treatment
|
$1,206.95
|
$1,236.56
|
$29.61
|
Treatment of AEs
|
$12.44
|
$12.46
|
$0.02
|
Management
|
$404.91
|
$404.95
|
$0.04
|
Hospitalisation
|
$4,826.22
|
$4,826.22
|
$0.00
|
TB transmissions
|
$93.90
|
$82.17
|
–$11.73
|
NAAT cost
|
$0.00
|
$130.00
|
$130.00
|
TOTAL
|
$6,544.41
|
$6,692.36
|
$147.95
|
AEs = adverse events; AFB = acid-fast bacilli; NAAT = nucleic acid amplification test; TB = tuberculosis
Table 112 Weighted utility by outcome state, TB high scenario
True status
|
Treated status
|
AFB
|
AFB + NAAT
|
Increment
|
No TB
|
Untreated
|
0.000
|
0.000
|
0.000
|
No TB
|
Standard treatment
|
1.091
|
1.091
|
0.000
|
No TB
|
MDR treatment
|
0.000
|
0.000
|
0.000
|
TB
|
Untreated
|
0.000
|
0.000
|
0.000
|
TB
|
Standard treatment
|
0.295
|
0.293
|
–0.003
|
TB
|
MDR treatment
|
0.000
|
0.002
|
0.002
|
MDR-TB
|
Untreated
|
0.000
|
0.000
|
0.000
|
MDR-TB
|
Standard treatment
|
0.005
|
0.001
|
–0.004
|
MDR-TB
|
MDR treatment
|
0.000
|
0.004
|
0.004
|
TOTAL
|
-
|
1.391
|
1.391
|
0.0001
|
Note: The outcomes associated with the correct treatment are highlighted.
AFB = acid-fast bacilli; MDR = multidrug-resistant; NAAT = nucleic acid amplification test; TB = tuberculosis
Incorporating costs in a stepped manner
Table 113 Stepped economic evaluation, TB low and TB high scenarios
Utilities considered
|
Costs included (NAAT cost applied in AFB + NAAT arm)
|
ICER
|
TB low scenario
|
-
|
-
|
Index patient utility
|
Treatment only
|
$75,861
|
Index patient utility
|
Treatment and AEs
|
$75,835
|
Index patient utility
|
Treatment, AEs and management
|
$74,891
|
Index patient utility
|
Treatment, AEs, management and hospitalisation
|
$57,491
|
Index patient utility
|
Treatment, AEs, management, hospitalisation and transmission
|
$21,327
|
Index and secondary case utility
|
Treatment, AEs, management, hospitalisation and transmission
|
$18,533
|
Perfect clinical judgment scenario
|
-
|
-
|
Index patient utility
|
Treatment only
|
$1,174,732
|
Index patient utility
|
Treatment and AEs
|
$1,174,199
|
Index patient utility
|
Treatment, AEs and management
|
$1,157,291
|
Index patient utility
|
Treatment, AEs, management and hospitalisation
|
$885,893
|
Index patient utility
|
Treatment, AEs, management, hospitalisation and transmission
|
$794,067
|
Index and secondary case utility
|
Treatment, AEs, management, hospitalisation and transmission
|
$724,423
|
TB high scenario
|
-
|
-
|
Index patient utility
|
Treatment only
|
$2,163,187
|
Index patient utility
|
Treatment and AEs
|
$2,163,492
|
Index patient utility
|
Treatment, AEs and management
|
$2,164,093
|
Index patient utility
|
Treatment, AEs, management and hospitalisation
|
$2,164,093
|
Index patient utility
|
Treatment, AEs, management, hospitalisation and transmission
|
$2,005,150
|
Index and secondary case utility
|
Treatment, AEs, management, hospitalisation and transmission
|
$1,713,838
|
AEs = adverse events; ICER = incremental cost-effectiveness ratio
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