Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia
Why is this work in the frame?
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
No Canadian affiliation. An affiliation-only frame — the usual design — would never have seen this work. It is one of the works that make the case for inverting the frame.
The three-model screen
all 1,000 screened works →All three models called this out of scope.
Cost-effectiveness analysis of a tuberculosis active case finding program in Zambia; a health-program evaluation.
It evaluates tuberculosis case-finding cost-effectiveness, not research itself.
Cost-effectiveness of TB active case finding in Zambia; public health intervention evaluation.
Abstract
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Stored with the screening record, where it is evidence for the labels above.
The record
- Venue
- PLoS ONE
- Topic
- Tuberculosis Research and Epidemiology
- Field
- Medicine
- Canadian institutions
- —
- Funders
- Global Affairs CanadaKorea Health Industry Development InstituteBill and Melinda Gates Foundation
- Keywords
- MedicinePsychological interventionTuberculosisCost effectivenessIntervention (counseling)Cost-effectiveness analysisEmergency medicineCost–benefit analysisMortality rateCost databaseHealth careIntensive care medicineEnvironmental healthMedical emergencyFamily medicineNursingSurgeryRisk analysis (engineering)Pathology
- Has abstract in OpenAlex
- yes