The authors evaluated the costs of centralized and decentralized testing for tuberculosis with Xpert MTB/RIF (Xpert), a WHO-endorsed test. They used an agent-based simulation of TB transmission in a hypothetical representative region in India to assess the impact and cost-effectiveness of various strategies to provide universal access to diagnosis and drug susceptibility testing (DST) for tuberculosis. The authors found that decentralization was most favorable compared to centralized testing when volume at decentralized facilities was high, and specimen transport network was exclusively established for TB. Assuming equal quality of centralized and decentralized testing, decentralization was cost-saving in the most cost-favorable scenario. In the most cost-unfavorable scenario, decentralized testing would cost a median $3161 per disability-adjusted life year averted relative to centralized testing.
Sohn H, Kasaie P, Kendall E et al. Informing Decision-Making for Universal Access to Quality Tuberculosis Diagnosis In India: An Economic-Epidemiological Model. BMC Med. 2019 Aug 6;17(1):155. doi: 10.1186/s12916-019-1384-8.