How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India

BMC Medicine

David W Dowdy²  Jonathan E Golub¹  Andrew S Azman² 

[1] Center for Tuberculosis Research, Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, 1550 Orleans St., Baltimore 21231, MD, USA;Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore 21205, MD, USA

关键词: TB;    Tuberculosis;    Active Case Finding;    Cost-Effectiveness;    Screening;    Mathematical Modeling;   

Others  :  1118309
DOI  :  10.1186/s12916-014-0216-0

 received in 2014-08-07, accepted in 2014-10-16,  发布年份 2014

【 摘 要 】

Background

Current approaches are unlikely to achieve the aggressive global tuberculosis (TB) control targets set for 2035 and beyond. Active case finding (ACF) may be an important tool for augmenting existing strategies, but the cost-effectiveness of ACF remains uncertain. Program evaluators can often measure the cost of ACF per TB case detected, but how this accessible measure translates into traditional metrics of cost-effectiveness, such as the cost per disability-adjusted life year (DALY), remains unclear.

Methods

We constructed dynamic models of TB in India, China, and South Africa to explore the medium-term impact and cost-effectiveness of generic ACF activities, conceptualized separately as discrete (2-year) campaigns and as continuous activities integrated into ongoing TB control programs. Our primary outcome was the cost per DALY, measured in relationship to the cost per TB case actively detected and started on treatment.

Results

Discrete campaigns costing up to $1,200 (95% uncertainty range [UR] 850–2,043) per case actively detected and started on treatment in India, $3,800 (95% UR 2,706–6,392) in China, and $9,400 (95% UR 6,957–13,221) in South Africa were all highly cost-effective (cost per DALY averted less than per capita gross domestic product). Prolonged integration was even more effective and cost-effective. Short-term assessments of ACF dramatically underestimated potential longer term gains; for example, an assessment of an ACF program at 2 years might find a non-significant 11% reduction in prevalence, but a 10-year evaluation of that same intervention would show a 33% reduction.

Conclusions

ACF can be a powerful and highly cost-effective tool in the fight against TB. Given that short-term assessments may dramatically underestimate medium-term effectiveness, current willingness to pay may be too low. ACF should receive strong consideration as a basic tool for TB control in most high-burden settings, even when it may cost over $1,000 to detect and initiate treatment for each extra case of active TB.

【 授权许可】

   
2014 Azman et al.; licensee BioMed Central Ltd.

【 图 表 】

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