TitleThe Incremental Cost Of Introducing Xpert® MTB/RIF into the South African National Tuberculosis Programme
AuthorsMeyer-Rath G., Bistline K., Long L., MacLeod W., Sanne I., Stevens W., Rosen S.
PublisherHealth Economics and Epidemiology Research Office, Wits Health Consortium, University of the Witwatersrand (HE2RO)
LocationJohannesburg, South Africa; Boston, MA


South Africa bears a large share of the global burden of HIV/tuberculosis co-infection. The Cepheid GeneXpert System using the Xpert MTB/RIF assay (, a cassette-based cartridge, has provided the possibility of a rapid, point-of-care diagnosis of tuberculosis (TB) and, simultaneously, a rapid screen for rifampicin (RIF) resistance. The assay is highly sensitive and specific for M. tuberculosis (MTB) infection and received a strong recommendation from the World Health Organization (WHO) in December 2010 as the initial test in individuals suspected of multi-drug resistant (MDR) tuberculosis and those with HIV co-infection. Building on a successful pilot (Phase 1), the South African Department of Health requested the National Health Laboratory System (NHLS) to roll out Xpert technology in a phased manner. In Phase 2A, existing Xpert-enabled laboratories are to be upgraded to allow complete migration from smear microscopy for diagnosis of new patients. During Phase 2B, remaining laboratories in designated high TB caseload districts are to be Xpert-enabled over a 2-3 month period. In Phase 3, all other NHLS laboratories performing smear microscopy will become Xpert-enabled, fully replacing smear microscopy for the diagnosis of TB in South Africa, though microscopy will still retain a role in TB treatment monitoring. In May 2011, the Health Economics and Epidemiology Office of the University of the Witwatersrand was asked to estimate the incremental cost of the Xpert diagnostic algorithm in diagnosing pulmonary TB over and above the cost of the current diagnostic guidelines.

Policy Relevance

South Africa began its pilot phase of utilising Xpert MTB/RIF technology in March 2011 with the placement of 30 instruments in public-sector laboratories in high case-load districts. In his budget speech in May 2011, the South African Minister of Health announced the roll-out of Xpert technology to one laboratory in each of the country’s 50 health districts by the end of 2011, and the capacitation of all remaining facilities by the end of 2012 (the accelerated scale-up scenario used in this analysis). The analysis presented here is being used by the government to plan and budget for this endeavour and will provide the tools needed to understand the cost implications of different scale-up strategies.
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Related ProjectsImpact and Economics of Tuberculosis Prevention and Treatment in South Africa