scholarly journals Cost-effectiveness of active case-finding of household contacts of pulmonary tuberculosis patients in a low HIV, tuberculosis-endemic urban area of Lima, Peru

2017 ◽  
Vol 145 (6) ◽  
pp. 1107-1117 ◽  
Author(s):  
L. SHAH ◽  
M. ROJAS ◽  
O. MORI ◽  
C. ZAMUDIO ◽  
J. S. KAUFMAN ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Test ◽  
Cost Effective ◽  
Case Finding ◽  
Self Report ◽  
Urban Setting ◽  
Active Case Finding ◽  
Active Case ◽  
Household Contacts ◽  
Life Years

SUMMARYWe compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.

scholarly journals Expanding Tuberculosis Case Detection by Screening Household Contacts

2005 ◽  
Vol 120 (3) ◽  
pp. 271-277 ◽  
Author(s):  
Mercedes C. Becerra ◽  
Iliana F. Pachao-Torreblanca ◽  
Jaime Bayona ◽  
Rosa Celi ◽  
Sonya S. Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Finding ◽  
Self Report ◽  
Contact Tracing ◽  
Sputum Smear ◽  
Case Detection ◽  
Active Case Finding ◽  
Active Case ◽  
Tb Control ◽  
Household Contacts

Objectives. Tuberculosis (TB) case detection remains low in many countries, compromising the efficacy of TB control efforts. Current global TB control policy emphasizes case finding through sputum smear microscopy for patients who self-report to primary health centers. Our objective was to assess the feasibility and yield of a simple active case finding strategy in a high incidence population in northern Lima, Peru. Methods. We implemented this pilot strategy in one health center's catchment area. Health workers visited household contacts of new TB case subjects to identify symptomatic individuals and collect sputum for screening. Neighboring households were screened in the same manner. Secondary analyses measured risk of TB by ( 1) sputum smear status of the index case subject, ( 2) compliance with testing, and ( 3) risk factors for disease detected through active contact tracing in contrast to self-report. Results. The TB prevalence detected through combined active and passive case finding among 1,094 household contacts was 0.91% (914 per 100,000), much higher than with passive case finding alone (0.18%; 183 per 100,000; p=0.02). Among 2,258 neighbors, the combined strategy detected a TB prevalence of 0.22% (221 per 100,000) in contrast to 0.08% (80 per 100,000) detected through passive case finding alone ( p=0.25). Risk factors for being diagnosed through active case finding in contrast with self-report included age >55 years (odds ratio [OR]=5.5; 95% confidence interval [CI] 1.2, 22.8) and female gender (OR=3.9; 95% CI 0.99, 22.3). Conclusions. Risk of active TB among symptomatic household contacts of active case subjects in this community is very high. Results suggest that contact tracing in such settings may be a powerful means of improving case detection rates for active TB disease.

scholarly journals The cost-effectiveness of incentive-based active case finding for tuberculosis (TB) control in the private sector Karachi, Pakistan

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hamidah Hussain ◽  
Amani Thomas Mori ◽  
Aamir J. Khan ◽  
Saira Khowaja ◽  
Jacob Creswell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Private Sector ◽  
Health Sector ◽  
Cost Effective ◽  
Case Finding ◽  
Active Case Finding ◽  
Tree Model ◽  
Active Case ◽  
Tb Control ◽  
The Cost

Abstract Background In Asia, over 50% of patients with symptoms of tuberculosis (TB) access health care from private providers. These patients are usually not notified to the National TB Control Programs, which contributes to low notification rates in many countries. Methods From January 1, 2011 to December 31, 2012, Karachi’s Indus Hospital - a private sector partner to the National TB Programme - engaged 80 private family clinics in its catchment area in active case finding using health worker incentives to increase notification of TB disease. The costs incurred were estimated from the perspective of patients, health facility and the program providing TB services. A Markov decision tree model was developed to calculate the cost-effectiveness of the active case finding as compared to case detection through the routine passive TB centers. Pakistan has a large private health sector, which can be mobilized for TB screening using an incentivized active case finding strategy. Currently, TB screening is largely performed in specialist public TB centers through passive case finding. Active and passive case finding strategies are assumed to operate independently from each other. Results The incentive-based active case finding program costed USD 223 per patient treated. In contrast, the center based non-incentive arm was 23.4% cheaper, costing USD 171 per patient treated. Cost-effectiveness analysis showed that the incentive-based active case finding program was more effective and less expensive per DALY averted when compared to the baseline passive case finding as it averts an additional 0.01966 DALYs and saved 15.74 US$ per patient treated. Conclusion Both screening strategies appear to be cost-effective in an urban Pakistan context. Incentive driven active case findings of TB in the private sector costs less and averts more DALYs per health seeker than passive case finding, when both alternatives are compared to a common baseline situation of no screening.

scholarly journals Economic Evaluation of Community Tuberculosis Active Case-Finding Approaches in Cambodia: A Quasi-Experimental Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12690
Author(s):  
Alvin Kuo Jing Teo ◽  
Kiesha Prem ◽  
Yi Wang ◽  
Tripti Pande ◽  
Marina Smelyanskaya ◽  
...  
Keyword(s):  
Experimental Study ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Case Finding ◽  
Active Case Finding ◽  
Community Based ◽  
Active Case ◽  
Number Needed To Screen ◽  
Life Years ◽  
Quasi Experimental

This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective.

scholarly journals The Use of Xpert MTB/Rif for Active Case Finding among TB Contacts in North West Province, South Africa

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Limakatso Lebina ◽  
Nigel Fuller ◽  
Tolu Osoba ◽  
Lesley Scott ◽  
Katlego Motlhaoleng ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Turnaround Time ◽  
Case Finding ◽  
Contact Tracing ◽  
Active Case Finding ◽  
North West ◽  
Active Case ◽  
Household Contacts ◽  
Significant Difference ◽  
Diagnosis Rate

Introduction.Tuberculosis is a major cause of morbidity and mortality especially in high HIV burden settings. Active case finding is one strategy to potentially reduce TB disease burden. Xpert MTB/Rif has recently been recommended for diagnosis of TB.Methods.Pragmatic randomized trial to compare diagnosis rate and turnaround time for laboratory testing for Xpert MTB/Rif with TB microscopy and culture in household contacts of patients recently diagnosed with TB.Results.2464 household contacts enrolled into the study from 768 active TB index cases. 1068 (44%) were unable to give sputum, but 24 of these were already on TB treatment. 863 (53%) participants sputum samples were tested with smear and culture and 2.7% (23/863; CI: 1.62–3.78) were diagnosed with active TB. Xpert MTB/Rif was used in 515 (21%) participants; active TB was diagnosed in 1.6% (8/515; CI: 0.52–2.68).Discussion and Conclusions.Additional 31 cases were diagnosed with contact tracing of household members. When Xpert MTB/Rif is compared with culture, there is no significant difference in diagnostic yield.

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