Cost-Effectiveness of Targeted Next-Generation Sequencing for Diagnosing Pre-XDR and XDR Tuberculosis in Rifampicin-Resistant Patients Across High-Burden Settings.

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Τίτλος:	Cost-Effectiveness of Targeted Next-Generation Sequencing for Diagnosing Pre-XDR and XDR Tuberculosis in Rifampicin-Resistant Patients Across High-Burden Settings.
Συγγραφείς:	Fekadu G; Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong; School of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia. Electronic address: take828pharm@gmail.com., Tolossa T; Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Victoria, Australia; School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia., Labata BG; School of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia., Fite MB; School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia., Feyissa TR; Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia., Yi X; Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong., Chan SC; Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong., Chen Y; Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong; College of Nursing, Jinan University, Guangzhou, China., Arpa C; Department of Empirical Health Economics, Technische Universität Berlin, Berlin, Germany; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany., Bekele F; School of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia., Gao L; Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Victoria, Australia., Chaiyakunapruk N; Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA; IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA., Yang L; School of Public Health, Sun Yat-sen University, Guangzhou, China; Institute for Global Health and Development, Peking University, Beijing, China; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Jeldu M; Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia., Chen S; International Centre for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK., Siegel M; Chair of General Economics, Health Economics and Econometrics, University of Greifswald, Greifswald, Germany., Ming WK; Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong; Institute of Global Governance and Innovation for a Shared Future, City University of Hong Kong, Hong Kong. Electronic address: wkming2@cityu.edu.hk.
Πηγή:	Archivos de bronconeumologia [Arch Bronconeumol] 2026 Apr 24. Date of Electronic Publication: 2026 Apr 24.
Publication Model:	Ahead of Print
Τύπος έκδοσης:	Journal Article
Γλώσσα:	English; Spanish; Castilian
Στοιχεία περιοδικού:	Publisher: Elsevier España Country of Publication: Spain NLM ID: 0354720 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1579-2129 (Electronic) Linking ISSN: 03002896 NLM ISO Abbreviation: Arch Bronconeumol Subsets: MEDLINE
Imprint Name(s):	Publication: Madrid: Elsevier España Original Publication: Madrid : Sociedad Española de Patología Respiratoria [1964]-
Περίληψη:	Objectives: To evaluate whether targeted next-generation sequencing (tNGS)-alone or in combination with phenotypic drug susceptibility testing (pDST)-is cost-effective for diagnosing pre-extensively drug-resistant and extensively drug-resistant tuberculosis (pre-XDR/XDR-TB) in rifampicin-resistant tuberculosis (RR-TB) patients across South Africa, India, and Georgia, and to quantify mortality reduction from earlier treatment initiation enabled by rapid molecular diagnostics. Methods: We developed a decision-analytic model combining a short-term decision tree with a 10-year Markov model to simulate outcomes in a hypothetical RR-TB cohort. Three diagnostic strategies were compared: pDST, tNGS, and tNGS+pDST. Outcomes included costs, quality-adjusted life years (QALYs), early treatment initiation, TB-related mortality, and incremental cost-effectiveness ratios (ICERs). Cost-effectiveness was assessed against country-specific willingness-to-pay (WTP) thresholds. Sensitivity analyses were conducted to characterize uncertainty. Results: Tngs-based strategies improved early treatment initiation (South Africa: +9.8%; India: +19.1%; Georgia: +29.6%) and reduced mortality across all settings. In South Africa, tNGS was cost-effective (ICER, $2805/QALY). In Georgia, the combination strategy was cost-effective (ICER, $6361/QALY). In India, neither tNGS (ICER, $4453/QALY) nor the combination strategy (ICER, $6198/QALY) met the WTP threshold; tNGS would require cost reduction to ≤$116/test. The HR, for delayed treatment and tNGS cost were primary ICER drivers. Probabilistic analysis confirmed robustness, with tNGS cost-effective in 58% of simulations in South Africa and the combination strategy in 42% in Georgia. Conclusions: Tngs is cost-effective in South Africa and Georgia when the survival benefit of earlier treatment initiation is accounted for. In India, tNGS pricing exceeds affordability thresholds, necessitating cost reductions and targeted deployment. These findings provide context-specific guidance for national TB programs. (Copyright © 2026 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)
Contributed Indexing:	Keywords: Cost-effectiveness analysis; Drug-resistant tuberculosis; Early treatment initiation; High-burden settings; Pre-XDR/XDR-TB; Targeted next-generation sequencing
Entry Date(s):	Date Created: 20260514 Latest Revision: 20260514
Update Code:	20260515
DOI:	10.1016/j.arbres.2026.04.007
PMID:	42135169
Βάση Δεδομένων:	MEDLINE

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ISSN:	1579-2129
DOI:	10.1016/j.arbres.2026.04.007