Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia.
<h4>Introduction</h4>Active-case finding (ACF) programs have an important role in addressing case detection gaps and halting tuberculosis (TB) transmission. Evidence is limited on the cost-effectiveness of ACF interventions, particularly on how their value is impacted by different operat...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0256531 |
| _version_ | 1818997295968944128 |
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| author | Youngji Jo Mary Kagujje Karl Johnson David Dowdy Peter Hangoma Lophina Chiliukutu Monde Muyoyeta Hojoon Sohn |
| author_facet | Youngji Jo Mary Kagujje Karl Johnson David Dowdy Peter Hangoma Lophina Chiliukutu Monde Muyoyeta Hojoon Sohn |
| author_sort | Youngji Jo |
| collection | DOAJ |
| description | <h4>Introduction</h4>Active-case finding (ACF) programs have an important role in addressing case detection gaps and halting tuberculosis (TB) transmission. Evidence is limited on the cost-effectiveness of ACF interventions, particularly on how their value is impacted by different operational, epidemiological and patient care-seeking patterns.<h4>Methods</h4>We evaluated the costs and cost-effectiveness of a combined facility and community-based ACF intervention in Zambia that utilized mobile chest X-ray with computer-aided reading/interpretation software and laboratory-based Xpert MTB/RIF testing. Programmatic costs (in 2018 US dollars) were assessed from the health system perspective using prospectively collected cost and operational data. Cost-effectiveness of the ACF intervention was assessed as the incremental cost per TB death averted over a five-year time horizon using a multi-stage Markov state-transition model reflecting patient symptom-associated care-seeking and TB care under ACF compared to passive care.<h4>Results</h4>Over 18 months of field operations, the ACF intervention costed $435 to diagnose and initiate treatment for one person with TB. After accounting for patient symptom-associated care-seeking patterns in Zambia, we estimate that this one-time ACF intervention would incrementally diagnose 407 (7,207 versus 6,800) TB patients and avert 502 (611 versus 1,113) TB-associated deaths compared to the status quo (passive case finding), at an incremental cost of $2,284 per death averted over the next five-year period. HIV/TB mortality rate, patient symptom-associated care-seeking probabilities in the absence of ACF, and the costs of ACF patient screening were key drivers of cost-effectiveness.<h4>Conclusions</h4>A one-time comprehensive ACF intervention simultaneously operating in public health clinics and corresponding catchment communities can have important medium-term impact on case-finding and be cost-effective in Zambia. The value of such interventions increases if targeted to populations with high HIV/TB mortality, substantial barriers (both behavioral and physical) to care-seeking exist, and when ACF interventions can optimize screening by achieving operational efficiency. |
| first_indexed | 2024-12-20T21:43:22Z |
| format | Article |
| id | doaj.art-4739648644f54e1f9ee78aea3b0d1948 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-20T21:43:22Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-4739648644f54e1f9ee78aea3b0d19482022-12-21T19:25:44ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01169e025653110.1371/journal.pone.0256531Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia.Youngji JoMary KagujjeKarl JohnsonDavid DowdyPeter HangomaLophina ChiliukutuMonde MuyoyetaHojoon Sohn<h4>Introduction</h4>Active-case finding (ACF) programs have an important role in addressing case detection gaps and halting tuberculosis (TB) transmission. Evidence is limited on the cost-effectiveness of ACF interventions, particularly on how their value is impacted by different operational, epidemiological and patient care-seeking patterns.<h4>Methods</h4>We evaluated the costs and cost-effectiveness of a combined facility and community-based ACF intervention in Zambia that utilized mobile chest X-ray with computer-aided reading/interpretation software and laboratory-based Xpert MTB/RIF testing. Programmatic costs (in 2018 US dollars) were assessed from the health system perspective using prospectively collected cost and operational data. Cost-effectiveness of the ACF intervention was assessed as the incremental cost per TB death averted over a five-year time horizon using a multi-stage Markov state-transition model reflecting patient symptom-associated care-seeking and TB care under ACF compared to passive care.<h4>Results</h4>Over 18 months of field operations, the ACF intervention costed $435 to diagnose and initiate treatment for one person with TB. After accounting for patient symptom-associated care-seeking patterns in Zambia, we estimate that this one-time ACF intervention would incrementally diagnose 407 (7,207 versus 6,800) TB patients and avert 502 (611 versus 1,113) TB-associated deaths compared to the status quo (passive case finding), at an incremental cost of $2,284 per death averted over the next five-year period. HIV/TB mortality rate, patient symptom-associated care-seeking probabilities in the absence of ACF, and the costs of ACF patient screening were key drivers of cost-effectiveness.<h4>Conclusions</h4>A one-time comprehensive ACF intervention simultaneously operating in public health clinics and corresponding catchment communities can have important medium-term impact on case-finding and be cost-effective in Zambia. The value of such interventions increases if targeted to populations with high HIV/TB mortality, substantial barriers (both behavioral and physical) to care-seeking exist, and when ACF interventions can optimize screening by achieving operational efficiency.https://doi.org/10.1371/journal.pone.0256531 |
| spellingShingle | Youngji Jo Mary Kagujje Karl Johnson David Dowdy Peter Hangoma Lophina Chiliukutu Monde Muyoyeta Hojoon Sohn Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia. PLoS ONE |
| title | Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia. |
| title_full | Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia. |
| title_fullStr | Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia. |
| title_full_unstemmed | Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia. |
| title_short | Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia. |
| title_sort | costs and cost effectiveness of a comprehensive tuberculosis case finding strategy in zambia |
| url | https://doi.org/10.1371/journal.pone.0256531 |
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