Cost-effective diagnostic strategies for targeted mass screening campaigns: Pooled GeneXpert vs. TB-LAMP testing in Ethiopia
1
Monitoring, Evaluation and Research, REACH Ethiopia, Addis Ababa, Ethiopia
Popul. Med. 2026;8(Supplement Supplement 1):A500
ABSTRACT
BACKGROUND:
Mass screening and treatment (MSaT) campaigns are critical in detecting undiagnosed TB cases, particularly in asymptomatic individuals, helping to interrupt transmission and reduce disease burden. However, these campaigns are resource-intensive and logistically complex, especially in high TB burden countries like Ethiopia, where limited resources and the global economic crisis strain health systems. This operational study compared the cost-effectiveness and diagnostic performance of two TB diagnostic tools—pooled GeneXpert and TB-LAMP testing during community-based screening campaigns in both urban and pastoralist settings.
METHODS:
A total of 2,055 sputum samples were collected and tested using pooled GeneXpert (4:1 ratio), resulting in 514 pooled tests and 41 deconvolution tests. In parallel, 672 samples were tested using TB-LAMP to compare accuracy, throughput, and cost metrics. The study considered both direct and indirect costs—including consumables, labor, equipment, and patient time—and calculated the unit cost per test, cost per TB case detected, and the incremental cost-effectiveness ratio (ICER).
RESULTS:
Both methods achieved 100% concordance in TB case detection. The positivity rate was 1.4% for pooled GeneXpert and 2.0% for TB-LAMP. Pooled GeneXpert testing saved 1,500 cartridges—approximately USD $15,000. The unit cost per test was $3.20 for pooled GeneXpert and $4.30 for TB-LAMP. The cost per TB case detected was $136 and $197, respectively. GeneXpert cartridge costs accounted for 47% of total test costs, while TB-LAMP consumables made up 45% of its costs. TB-LAMP demonstrated higher throughput, processing up to 112 samples/day compared to 32/day for a 4-module GeneXpert machine.
CONCLUSIONS:
Both tests were diagnostically reliable, but pooled GeneXpert offered greater cost savings and efficiency. When paired with high-quality specimens, pooled testing is a novel, scalable solution for resource-limited settings. It enables broader coverage, faster results, and cost-effective TB case detection—key elements for successful MSaT campaigns and advancing toward TB elimination goals.
Mass screening and treatment (MSaT) campaigns are critical in detecting undiagnosed TB cases, particularly in asymptomatic individuals, helping to interrupt transmission and reduce disease burden. However, these campaigns are resource-intensive and logistically complex, especially in high TB burden countries like Ethiopia, where limited resources and the global economic crisis strain health systems. This operational study compared the cost-effectiveness and diagnostic performance of two TB diagnostic tools—pooled GeneXpert and TB-LAMP testing during community-based screening campaigns in both urban and pastoralist settings.
METHODS:
A total of 2,055 sputum samples were collected and tested using pooled GeneXpert (4:1 ratio), resulting in 514 pooled tests and 41 deconvolution tests. In parallel, 672 samples were tested using TB-LAMP to compare accuracy, throughput, and cost metrics. The study considered both direct and indirect costs—including consumables, labor, equipment, and patient time—and calculated the unit cost per test, cost per TB case detected, and the incremental cost-effectiveness ratio (ICER).
RESULTS:
Both methods achieved 100% concordance in TB case detection. The positivity rate was 1.4% for pooled GeneXpert and 2.0% for TB-LAMP. Pooled GeneXpert testing saved 1,500 cartridges—approximately USD $15,000. The unit cost per test was $3.20 for pooled GeneXpert and $4.30 for TB-LAMP. The cost per TB case detected was $136 and $197, respectively. GeneXpert cartridge costs accounted for 47% of total test costs, while TB-LAMP consumables made up 45% of its costs. TB-LAMP demonstrated higher throughput, processing up to 112 samples/day compared to 32/day for a 4-module GeneXpert machine.
CONCLUSIONS:
Both tests were diagnostically reliable, but pooled GeneXpert offered greater cost savings and efficiency. When paired with high-quality specimens, pooled testing is a novel, scalable solution for resource-limited settings. It enables broader coverage, faster results, and cost-effective TB case detection—key elements for successful MSaT campaigns and advancing toward TB elimination goals.
| eISSN: | 2654-1459 |
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