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...

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Autores principales:	Youngji Jo, Mary Kagujje, Karl Johnson, David Dowdy, Peter Hangoma, Lophina Chiliukutu, Monde Muyoyeta, Hojoon Sohn
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4739648644f54e1f9ee78aea3b0d1948
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spelling	oai:doaj.org-article:4739648644f54e1f9ee78aea3b0d19482021-12-02T20:08:25ZCosts and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia.1932-620310.1371/journal.pone.0256531https://doaj.org/article/4739648644f54e1f9ee78aea3b0d19482021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256531https://doaj.org/toc/1932-6203<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.Youngji JoMary KagujjeKarl JohnsonDavid DowdyPeter HangomaLophina ChiliukutuMonde MuyoyetaHojoon SohnPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0256531 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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.
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.
format	article
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
title	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_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_sort	costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in zambia.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/4739648644f54e1f9ee78aea3b0d1948
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Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia.

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