To impact TB globally, Xpert MTB/RIF and other diagnostics must be scaled-up across numerous clinical settings, after careful evaluation of expected costs and benefits. Unfortunately, standard cost-effectiveness analyses are ill-suited to guide local decision-makers in directing scale-up activities. We demonstrate the limitations of standard economic analyses as applied to scale-up of TB diagnostics (specifically Xpert MTB/RIF), and recommend adaptations to future analyses that will facilitate rational and effective scale-up activities.
Dowdy, D.W.; Cattamanchi, A.; Steingart, K.R.; Pai, M. Is Scale-Up Worth It? Challenges in Economic Analysis of Diagnostic Tests for Tuberculosis. PLoS Medicine (2011) 8 (7) e1001063. [DOI: 10.1371/journal.pmed.1001063]