The Impact of Adopting Whole Genome Sequencing for Tuberculosis Diagnosis in China: A Cost-Effectiveness Analysis

Abstract Background China is a high-burden tuberculosis (TB) country and delays in diagnosis and effective treatment have further exacerbated this situation. Whole genome sequencing (WGS) has emerged as a reliable approach for drug susceptibility testing (DST) in TB. WGS can improve TB treatment outcomes but also requires significant investments in laboratory infrastructure and trained personnel. It is unclear whether WGS is a cost-effective strategy for routine TB diagnosis in China. Methods We developed a decision tree-Markov model to evaluate the cost-effectiveness and health impact of WGS-based DST compared to culture-based DST and rapid molecular testing strategies (Xpert and Xpert Ultra), adopting a societal perspective. Results Base case analysis demonstrated that WGS, Xpert, and Xpert Ultra were cost-saving strategies for TB management. Compared to culture-based DST, the incremental net monetary benefit (INMB) for Xpert, Xpert Ultra, and WGS were $1,750.06, $1,832.84, and $1,939.32, respectively. Over a lifetime horizon, WGS emerged as the optimal DST strategy, reducing direct medical costs by $401.83 per patient, gaining an additional 0.121 quality-adjusted life years (QALYs) per case, and decreasing TB mortality by 45 cases per 10,000 patients. Sensitivity analyses confirmed the robustness of these findings across key parameters. Conclusions WGS-based DST offers a cost-saving solution for TB patients in China, achieving better health and economic outcomes compared to alternative strategies. The findings suggest that the widespread adoption of WGS-based DST in China would be cost-effective and aligns well with public health priorities in high-burden settings.