Tuberculosis active case finding in Cambodia: a pragmatic, cost-effectiveness comparison of three implementation...

Area of Science:

• Public Health
• Epidemiology
• Health Economics

Background:

• Globally, nearly 40% of tuberculosis (TB) patients are undiagnosed, leading to delayed treatment and ongoing transmission.
• Active case finding (ACF) aims to improve early TB detection, but evidence on the cost-effectiveness of different ACF models is limited.
• Cambodia offers a unique setting to compare ACF implementation models due to varied approaches used.

Purpose of the Study:

• To compare the cost-effectiveness of different active case finding (ACF) implementation models for tuberculosis (TB) in Cambodia.
• To inform national TB policy and practice by providing evidence-based data on TB case detection costs.
• To contribute methodological insights into comparing ACF cost-effectiveness using programmatic data.

Main Methods:

• Retrospective comparison of three distinct ACF models: urban slum door-to-door screening, TB patient contact tracing, and rural elderly screening.
• Calculation of cost per additional bacteriologically-positive pulmonary TB case detected for each model.
• Utilized programmatic data from Cambodia's national TB program.

Main Results:

• Urban slum door-to-door screening was most cost-effective at $249 per case (737 cases diagnosed).
• TB patient contact tracing cost $308 per case (807 cases diagnosed).
• Rural elderly screening was least cost-effective at $316 per case (397 cases diagnosed).

Conclusions:

• Door-to-door screening in urban slums is the most economically viable ACF model for TB case finding in Cambodia.
• Cost-effectiveness comparisons are vital for resource allocation in resource-constrained settings.
• The study employed a pragmatic methodology using real-world programmatic data for policy relevance.