Cost-effectiveness of TrueNat as compared to GeneXpert as a diagnostic tool for diagnosis of pediatric tuberculosis/MDR Tuberculosis under the National Tuberculosis Elimination Program of India

Background: According to a study on global burden of tuberculosis (TB), India witnessed 60,000 pediatric deaths in the year 2015. In India, most of the children do not get diagnosed with tuberculosis for various reasons. Aims and Objectives: This study will evaluate the cost-effectiveness of TrueNat and GeneXpert diagnostic strategies used for tuberculosis detection in children, thus aiding policymakers for taking evidence-based decisions. Materials and Methods: For this cost-effectiveness study, a systematic review was done to extract the evidence for estimates of effectiveness of current TB diagnostic tools. Evidence pertinent to cost per test including all direct, indirect costs and health benefits in terms of quality-adjusted life years were researched and documented. Full economic evaluations available in the literature were also explored. Results: The results of the study showed that TrueNat is more cost-effective when compared to GeneXpert in the diagnosis of pediatric tuberculosis cases leading to more life years gained and deaths averted. 13,260 additional cases can be detected with TrueNat with an incremental cost of $14.36 per additional case detected. The incremental cost-effectiveness ratio per life year gained was found to be $20.01. Conclusion: TrueNat proved to be beneficial and cost-effective as compared to GeneXpert MTB being used in case of children. We recommend the use of TrueNat diagnostic test in India as it is in congruence with Indian health-care settings.