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

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BMC Medicine

, 12:216

Medicine for Global Health


BackgroundCurrent 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.

MethodsWe 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.

ResultsDiscrete 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.

ConclusionsACF 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.

KeywordsMathematical Modeling Screening Cost-Effectiveness Active Case Finding Tuberculosis TB AbbreviationsACFActive case finding

ARTAntiretroviral therapy

DALYDisability-adjusted life year

GDPGross domestic product

ICERIncremental cost-effectiveness ratio


URUncertainty range

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-014-0216-0 contains supplementary material, which is available to authorized users.

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Autor: Andrew S Azman - Jonathan E Golub - David W Dowdy


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