TY - JOUR
T1 - Rapid implementation of new TB diagnostic tests
T2 - Is it too soon for a global roll-out of Xpert MTB/RIF?
AU - Kirwan, Daniela E.
AU - Cárdenas, María Kathia
AU - Gilman, Robert H.
PY - 2012/8
Y1 - 2012/8
N2 - In 2011 the World Health Organization approved Xpert MTB/RIF for tuberculosis diagnosis and recommended its rapid implementation. Xpert MTB/RIF is accurate: sensitivity is 72.5-98.2% (smear-negative and -positive cases, respectively) and specificity 99.2%. Benefits include same-day diagnosis and simultaneous detection of rifampicin resistance. However, the test has some shortcomings and has not had time for thorough evaluation. Cost-effectiveness studies are difficult to perform and few have been completed. Existing data suggest cost-effectiveness in some, but not all, settings. The urgent need for better diagnostics is evident. Yet, serial implementation of new technologies causes ineffective spending and fragmentation of services. How new tests are incorporated into existing diagnostic algorithms affects both outcomes and costs. More detailed data on performance, effect on patient-important outcomes, and costs when used with adjunct tests are needed for each setting before implementation.While awaiting further clarification it seems prudent to slow its implementation among resource-constrained tuberculosis control programs.
AB - In 2011 the World Health Organization approved Xpert MTB/RIF for tuberculosis diagnosis and recommended its rapid implementation. Xpert MTB/RIF is accurate: sensitivity is 72.5-98.2% (smear-negative and -positive cases, respectively) and specificity 99.2%. Benefits include same-day diagnosis and simultaneous detection of rifampicin resistance. However, the test has some shortcomings and has not had time for thorough evaluation. Cost-effectiveness studies are difficult to perform and few have been completed. Existing data suggest cost-effectiveness in some, but not all, settings. The urgent need for better diagnostics is evident. Yet, serial implementation of new technologies causes ineffective spending and fragmentation of services. How new tests are incorporated into existing diagnostic algorithms affects both outcomes and costs. More detailed data on performance, effect on patient-important outcomes, and costs when used with adjunct tests are needed for each setting before implementation.While awaiting further clarification it seems prudent to slow its implementation among resource-constrained tuberculosis control programs.
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U2 - 10.4269/ajtmh.2012.12-0107
DO - 10.4269/ajtmh.2012.12-0107
M3 - Review article
C2 - 22855746
AN - SCOPUS:84864883432
SN - 0002-9637
VL - 87
SP - 197
EP - 201
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 2
ER -