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Cost-effectiveness of Low-complexity Screening Tests in Community-based Case-finding for Tuberculosis
Lukas E Brümmer1,2,3, Ryan R Thompson3, Akash Malhotra3
1Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.
Summary
Low-complexity tuberculosis (TB) screening tests can improve cost-effectiveness in community-based case-finding. However, these tests must be sensitive, specific, and inexpensive to maximize benefits for TB control.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Economics
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden regions.
- Community-based case-finding is crucial for TB control, but its cost-effectiveness can be limited.
- The role and economic impact of low-complexity screening tests in expanding TB case-finding are not well understood.
Purpose of the Study:
- To evaluate the cost-effectiveness of different community-based TB case-finding strategies.
- To compare universal sputum Xpert Ultra testing with strategies incorporating point-of-care C-reactive protein (CRP) or a novel hypothetical screening test.
Main Methods:
- A microsimulation model was developed to assess three TB case-finding approaches.
- The model simulated hypothetical populations in India, South Africa, The Philippines, Uganda, and Vietnam, with TB prevalence four times the national estimates.
- Costs included direct medical costs and treatment expenses, expressed in 2023 US dollars.
Main Results:
- Universal Xpert Ultra testing was estimated to cost $4.0 million per 100,000 people screened, averting 3200 disability-adjusted life years (DALYs).
- C-reactive protein (CRP) screening was projected to be more cost-effective per DALY averted ($550-$1500) but averted 44% fewer DALYs.
- A hypothetical screening test, if optimized for high sensitivity (95%) and specificity (95%) with a low cost ($4.5), could achieve a cost-effectiveness of $390-$940 per DALY averted.
Conclusions:
- Screening tests can enhance the cost-effectiveness of community-based TB case-finding.
- The effectiveness of screening tests is contingent upon their sensitivity, specificity, and cost.
- Optimized screening strategies hold potential for improving TB control efforts in resource-limited settings.
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