Presentation (CTI)

OBJECTIVES: Improving TB diagnosis in public primary health care (PHC) in India through increased use of nucleic acid amplification test (NAAT) diagnostics and reduced reliance on sputum smear microscopy (SSM) and chest x-rays (CXR) may raise treatment, thereby improving health.
METHODS: We conducted a clinical cost-effectiveness analysis from a health payer perspective of increased use of NAAT diagnostics for active pulmonary TB diagnosis and rifampicin resistance testing in public PHC facilities in India. We compared three intervention diagnostic strategies involving active TB diagnosis and rifampicin resistance testing with a prospective $2 (USD) near-point-of-care NAAT (“novel $2 NAAT”) and Truenat relative to a status quo of using SSM and CXR for active TB diagnosis and Truenat for rifampicin resistance testing. Using an individual microsimulation model, we measured lifetime disability-adjusted life years (DALYs) and costs for a nationally representative cohort of 20,000 15-year-olds self-presenting to PHC with presumptive TB.
RESULTS: All three intervention diagnostic strategies economically dominate the status quo, improving expected health while reducing expected costs. Net monentary benefits (NMB) per cohort member were $382.69 (2024 USD) for Trunat for both active TB diagnosis and resistance testing; $397 for the novel $2 NAAT for diagnosis and Truenat for resistance testing; and $964.63 for the novel $2 NAAT for both diagnosis and resistance testing. Across intervention diagnostic strategies, net health payer cost savings per cohort member ranged from $10.54 to $16.51, and the value of improved health per cohort member ranged from $372.15 to $949.11.
CONCLUSIONS: NAAT-based active TB diagnosis and rifampicin resistance testing in public PHC in India improves population health and reduces health sector costs, with the use of the $2 novel NAAT for both active TB diagnosis and resistance testing having the largest impact. These findings support adopting NAAT diagnostics for self-presenting presumptive pulmonary TB patients at PHC in India.