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

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. Whole-genome sequencing can not only 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 with 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 with culture-based DST, the incremental net monetary benefits for Xpert, Xpert Ultra, and WGS were $1750.06, $1832.84, and $1939.32, 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 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: Whole-genome sequencing-based DST offers a cost-saving solution for patients with TB in China, achieving better health and economic outcomes compared with 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.