Cassim, N.Omar, Shaheed VallyMasuku, S.D.Moultrie, H.Stevens, W.S.Ismail, FarzanaDa Silva, P.2025-05-072025-05-072024-05-01Cassim, N., Omar, S.V., Masuku, S.D. et al. 2024, 'Xpert MTB/XDR implementation in South Africa: cost outcomes of centralised vs. decentralised approaches', IJTLD Open, vol. 1, no. 5, pp. 215-222, doi : 10.5588/ijtldopen.23.0501.3005-7590 (online)10.5588/ijtldopen.23.0501http://hdl.handle.net/2263/102317INTRODUCTION : In South Africa, Xpert® MTB/RIF Ultra (Ultra) is the recommended diagnostic assay for TB with line-probe assays for first- (LPAfl) and second-line drugs (LPAsl) providing additional drug susceptibility testing (DST) for samples that were rifampicin-resistant (RR-TB). To guide implementation of the recently launched Xpert® MTB/XDR (MTB/XDR) assay, a cost-outcomes analysis was conducted comparing total costs for genotypic DST (gDST) for persons diagnosed with RR-TB considering three strategies: replacing LPAfl/LPAsl (centralised level) with MTB/XDR vs. Ultra reflex testing (decentralised level). Further, DST was performed using residual specimen following RR-TB diagnosis. METHODS : The total cost of gDST was determined for three strategies, considering loss to follow-up (LTFU), unsuccessful test rates, and specimen volume. RESULTS : For 2019, 9,415 persons were diagnosed with RR-TB. A 35% LTFU rate between RR-TB diagnosis and LPAfl/LPAsl-DST was estimated. Unsuccessful test rates of 37% and 23.3% were reported for LPAfl and LPAsl, respectively. The estimated total costs were $191,472 for the conventional strategy, $122,352 for the centralised strategy, and $126,838 for the decentralised strategy. However, it was found that sufficient residual volume for reflex MTB/XDR testing is a limiting factor at the decentralised level. CONCLUSION : Centralising the implementation of XDR testing, as compared to LPAfl/LPAsl, leads to significant cost savings.en© 2024 The Authors. This is an open access article published by The Union under the terms of the Creative Commons Attribution License CC-BY.Tuberculosis (TB)Drug susceptibility testing (DST)Rifampicin-resistant tuberculosis (RR-TB)Multidrug-resistant tuberculosis (MDR-TB)Line-probe assayArticle