Cost-effectiveness analysis of Xpert in detecting Mycobacterium tuberculosis: A systematic review

•Twenty-one studies conducted in areas with different TB burdens were included.•The published evidences in model-based cost-effectiveness analyses mostly supported Xpert in detecting TB in areas with various TB burdens.•Xpert is cost-effective in nations with socioeconomic differences, HIV stress and geographical distribution.•Cost-effectiveness comparisons are limited by the different aspects in the studies, cost parts in the analyses, and non-uniform measures of effectiveness and output. To report the cost-effectiveness of Xpert in detecting Mycobacterium tuberculosis (MTB) through a comprehensive systematic review. Specialized bibliographic databases were searched. Study quality was evaluated by commonly-used industry standards. Due to heterogeneity, evidences were synthesized narratively. Four studies from intermediate-to-low tuberculosis (TB)-burdern areas and 17 studies from high-TB-burden areas were included. Smear microscopy, clinical diagnosis and chest radiography were mostly used for comparison. Cost elements varied considerably depending on the perspectives. Cost-effectiveness and cost-utility analyses were used by seven and fourteen studies, respectively. All studies were of high quality (CHEERS score of 78.4 and QHES score of 86.9). Average cost per test was 29.8 US$ for Xpert compared with 3.83 US$ for smear microscopy. Cost-effectiveness analyses mostly supported application of Xpert into areas under varying TB burdens. Xpert seems cost-effective under respective willingness-to-pay thresholds in nations with differences in socioeconomy, HIV stress and geographical distribution. Nevertheless, policymakers will benefit from localized studies since regional economic/financial statuses and health-care system should also be considered apart from the reports of cost-effectiveness.