Cost of a new method of active screening for human African trypanosomiasis in the Democratic Republic of the Congo

Background Human African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease targeted for eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study compares the cost of two active case-finding approaches, namely the traditional mobile teams and mini mobile teams, in the two health districts of the Democratic Republic of the Congo. Methods The financial and economic costs of both approaches were estimated from a health care provider perspective. Cost and operational data were collected for 12 months for 1 traditional team and 3 mini teams. The cost per person screened and diagnosed was calculated and univariate sensitivity analysis was conducted to identify the main cost drivers. Results During the study period in total 264,630 people were screened, and 23 HAT cases detected. The cost per person screened was lower for a mini team than for a traditional team in the study setting (US$1.86 versus US$2.08). A comparable result was found in a scenario analysis, assuming both teams would operate in a similar setting, with the cost per person screened by a mini team 15% lower than the cost per person screened by a traditional team (1.86 $ vs 2.14$). The main explanations for this lower cost are that mini teams work with fewer human resources, cheaper means of transportation and do not perform the Capillary Tube Centrifugation test or card agglutination test dilutions. Discussion Active HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active case-finding. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.

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Cost of a new method of active screening for human African trypanosomiasis in the Democratic Republic of the Congo

10.1101/2020.06.25.20139717 ◽

2020 ◽

Author(s):

Rian Snijders ◽

Alain Fukinsia ◽

Yves Claeys ◽

Alain Mpanya ◽

Epco Hasker ◽

...

Keyword(s):

Human African Trypanosomiasis ◽

Democratic Republic ◽

Public Health Problem ◽

Cost Effective ◽

Active Case Finding ◽

Active Screening ◽

Populations At Risk ◽

Republic Of The Congo ◽

Cost Effective Alternative ◽

The Cost

ABSTRACTBackgroundHuman African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease that killed thousands of people at the start of the 20th century. Today, less than 1,000 cases are reported globally, and the disease is targeted for elimination and eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study aims to compare the cost of two approaches for active HAT screening, namely the traditional mobile teams and mini mobile teams.MethodsWe estimated annual economic costs for the two active HAT screening approaches from a health care provider perspective. Cost and operational data was collected for 12 months for 1 traditional team and 3 mini teams in the health districts of Yasa Bonga and Mosango in the Kwilu province of the Democratic Republic of the Congo. The cost per person screened and per person diagnosed was calculated. Univariate sensitivity analysis was conducted on important cost drivers.ResultsThe study shows that the cost per person screened is lower for a mini team compared to a traditional team in the study setting (US$1.86 compared to US$2.08) as well as in a simulation analysis assuming both teams would operate in a setting with similar disease prevalence.DiscussionActive HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active screening campaigns. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.AUTHOR SUMMARYHuman African Trypanosomiasis (HAT) used to be a major public health problem in Sub-Saharan Africa, but the disease is becoming less frequent today as a result of sustained control efforts. Currently, the elimination of sleeping sickness is targeted as a public health problem by 2020 with interruption of transmission by 2030. To achieve these targets, a long-term commitment towards HAT control activities will be necessary with innovative disease control approaches accompanied by economic evaluations to assess their cost and cost-effectiveness in the changing context. Today, active case finding conducted through mass outreach campaigns accounts for approximately half of all identified cases in the Democratic Republic of the Congo. However, this strategy has become less efficient, with a dwindling “yield” in terms of the number of identified cases, translating to a higher cost per diagnosed HAT case. Therefore, different approaches to outreach campaigns need to be evaluated with a focus on reaching populations at risk for HAT.This article presents the costs and outcomes of two approaches to active screening: traditional mobile teams and mini mobile teams.This study shows that mini mobile teams could be a cost-effective alternative for active screening with a cost-per-person screened of US$1.86 compared to US$2.08. This approach could increase the screening coverage of populations at risk for HAT that are currently not being reached through the traditional approach. Future research is needed to evaluate the difference in HAT cases identified and treated by both approaches. This would allow a cost-effectiveness comparison of both strategies based on the cost-per-person diagnosed and treated.

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Assessment of a health facility based active case finding system for Ebola virus disease in Mbandaka, Democratic Republic of the Congo, June–July 2018

BMC Infectious Diseases ◽

10.1186/s12879-019-4600-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Amber Kunkel ◽

Mory Keita ◽

Boubacar Diallo ◽

Olivier le Polain de Waroux ◽

Lorenzo Subissi ◽

...

Keyword(s):

Health Facility ◽

Ebola Virus ◽

Democratic Republic ◽

Virus Disease ◽

Case Definition ◽

Case Finding ◽

Suspected Case ◽

Active Case Finding ◽

Active Case ◽

Republic Of The Congo

Abstract Background The ninth outbreak of Ebola Virus Disease (EVD) in the Democratic Republic of the Congo occurred in Équateur Province from 8 May-24 July 2018. A system of health facility (HF)-based active case finding (ACF) was implemented in Mbandaka, a regional capital with four confirmed EVD cases, following completion of contact tracing. The goal of this HF-based ACF system was to look for undetected EVD cases among patients that visited HFs beginning one week prior to the system’s implementation. Methods From 23 June – 24 July 2018, ACF teams visited HFs in Mbandaka and reviewed all medical records as far back as 17 June for any consultations meeting the suspected EVD case definition. The teams then assessed whether to validate these as suspected EVD cases based on factors such as recovery, epidemiological links, and their clinical judgement. ACF teams also assessed HFs’ awareness of EVD symptoms and the process for alerting suspected cases. We calculated descriptive statistics regarding the characteristics of reviewed consultations, alert cases, and visited HFs. We also used univariate and multivariate random effects logistic regression models to evaluate the impact of repeated ACF visits to the same HF on the staff’s awareness of EVD. Results ACF teams reviewed 37,746 consultations, of which 690 met the definition of a suspected case of EVD. Two were validated as suspected EVD cases and transferred to the Ebola Treatment Unit for testing; both tested negative. Repeated ACF visits to the same HF were significantly associated with improved EVD awareness (p < 0.001) in univariate and multivariate analyses. Conclusion HF-based ACF during EVD outbreaks may improve EVD awareness and reveal many individuals meeting the suspected case definition. However, many who meet this definition may not have EVD, depending on the population size covered by ACF and amount of ongoing EVD transmission. Given the burdensome procedure of testing suspected EVD cases, future HF-based ACF systems would benefit from improved clarity on which patients require further testing.

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Comparison of yield and relative costs of different screening algorithms for tuberculosis in active case-finding: a cross-section study

BMC Infectious Diseases ◽

10.1186/s12879-021-06486-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fei Zhao ◽

Canyou Zhang ◽

Chongguang Yang ◽

Yinyin Xia ◽

Jin Xing ◽

...

Keyword(s):

Case Finding ◽

Active Case Finding ◽

Face To Face ◽

Active Case ◽

Symptom Screening ◽

Significant Difference ◽

National Tuberculosis ◽

Study Population ◽

The Difference ◽

The Cost

Abstract Background Part of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China. Methods The study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms. Results Algorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p < 0.01, Kappa 95% CI: 0. 93–0.99) and China NTP (p = 0.03, Kappa 95% CI: 0.96–1.00). There was a significant difference in the total costs among different three algorithms WHO 1c/2/3 (F = 59.13, p < 0.01). No significant difference in the average costs for one active TB case screened and diagnosed through the process among Algorithms 1c/2/3 was evident (F = 2.78, p = 0.07). The average costs for one bacteriological positive case through algorithm WHO 1a was about two times as much as the costs for one active TB case through algorithms WHO 1c/2/3. Conclusions Active case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding.

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The impact of active case finding among high-risk populations on the decline of tuberculosis incidence

Polish Annals of Medicine ◽

10.29089/2021.21.00185 ◽

2021 ◽

Author(s):

Aleksandra Tomczak ◽

Dominika Warmjak ◽

Aneta Wiśniewska

Keyword(s):

High Risk ◽

Disease Transmission ◽

Reproduction Number ◽

Case Finding ◽

Transmission Risk ◽

Active Case Finding ◽

Disease Dynamics ◽

Active Screening ◽

Active Case ◽

The Impact

Introduction: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. In 2019 the WHO reported approximately 10 million TB cases and 1.4 million deaths worldwide. TB still remains one of the leading causes of death in humans. Brazil is one of 30 countries with the highest TB burden with 96,000 new cases and 6,700 deaths reported in 2019. From 2015 the TB incidence is increasing by 2%–3% annually. It means that TB control programs need to be improved. Aim: Our aim is to show the impact of active case finding of TB cases among a high-risk subpopulation on decline of the incidence in the general population. Material and methods: We use a SIS-type compartmental mathematical model to describe the disease dynamics. We consider the population as a heterogeneous population which differ in disease transmission risk. Using best-fit techniques we compare the actual data with the model. For the fitted parameters we calculate the basic reproduction number and estimate the TB trends for the next few years applying several preventative protocols. Results and discussion: Using numerical simulations we examine the impact of ACF on the disease dynamics. We show that active screening among high risk subpopulations can help to reduce TB spread. We show how the reproduction number and estimated incidence decline depend on the detection rate. Conclusions: Active screening is one of the most effective ways for reducing the spread of disease. However, due to financial constraints, it can only be used to a limited extent. Properly applied detection can limit the spread of the disease while minimizing costs.

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The Impact of Funding on Childhood TB Case Detection in Pakistan

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed4040146 ◽

2019 ◽

Vol 4 (4) ◽

pp. 146 ◽

Cited By ~ 2

Author(s):

Amyn A. Malik ◽

Hamidah Hussain ◽

Jacob Creswell ◽

Sara Siddiqui ◽

Junaid F. Ahmed ◽

...

Keyword(s):

Case Finding ◽

Active Case Finding ◽

Average Case ◽

Active Case ◽

Implementation Period ◽

Childhood Tb ◽

Continuous Stream ◽

The Cost ◽

The Impact ◽

Case Notification

This study is a review of routine programmatically collected data to describe the 5-year trend in childhood case notification in Jamshoro district, Pakistan from January 2013 to June 2018 and review of financial data for the two active case finding projects implemented during this period. The average case notification in the district was 86 per quarter before the start of active case finding project in October 2014. The average case notification rose to 322 per quarter during the implementation period (October 2014 to March 2016) and plateaued at 245 per quarter during the post-implementation period (April 2016 to June 2018). In a specialized chest center located in the district, where active case finding was re-introduced during the post implementation period (October 2016), the average case notification was 218 per quarter in the implementation period and 172 per quarter in the post implementation period. In the rest of the district, the average case notification was 160 per quarter in the implementation period and 78 during the post implementation period. The cost per additional child with TB found ranged from USD 28 to USD 42 during the interventions. A continuous stream of resources is necessary to sustain high notifications of childhood TB.

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

BMC Health Services Research ◽

10.1186/s12913-019-4444-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

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.

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