A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe

Machekera, S. M.; Wilkinson, Ewan; Hinderaker, Sven Gudmund; Mabhala, Mzwandile A.; Zishiri, C.; Ncube, Ronald; Timire, Collins; Takarinda, Kudakwashe C; Sengai, Tonderai; Sandy, Charles

doi:10.5588/pha.18.0098

Cited by 5 publications

(13 citation statements)

References 20 publications

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“…However, the enhanced TB suspected symptoms in our study could help diagnose more active TB cases sooner, which was similar to that found in comparable studies [ 22 ]. Furthermore, compared with other studies in active screening for TB, our average screening costs for one active TB case was less than the same study in Russian Federation, despite the same level of TB incidence in both countries, but more than the studies in the higher TB-incidence countries [ 3 , 21 , 23 , 24 ]. In addition, if the active case-finding might be performed in targeted high-risk groups, the costs of performance could decrease undoubtedly.…”

Section: Discussioncontrasting

confidence: 50%

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

et al. 2021

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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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Section: Discussioncontrasting

confidence: 50%

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

et al. 2021

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“…This difference could be explained by the fact that only individuals with symptoms and abnormal CXR exam were eligible for sputum evaluation in the UTPS hence overestimation of the sensitivity at the cost of specificity. However, the use of the CXR increases the overall sensitivity hence an increased number of individuals being subjected to the confirmatory tests resulting into increased TB yield [ 21 , 22 ]. This is especially important in the era of the new advanced TB diagnostic tools such as the GeneXpert with high sensitivity and specificity [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy and Incremental Yield of the Chest X-Ray in Screening for Tuberculosis in Uganda: A Cross-Sectional Study

Nalunjogi

Mugabe

Najjingo

et al. 2021

Tuberculosis Research and Treatment

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The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be suboptimal since up to 44% of individuals with TB are asymptomatic. The chest X-ray (CXR) as a screening tool for pulmonary TB was evaluated in this study, as well as its incremental yield in TB diagnosis using a cross-sectional study involving secondary analysis of data of 4512 consented/assented participants ≥15 years who participated in the Uganda National TB prevalence survey between 2014 and 2015. Participants with a cough ≥2 weeks, fever, weight loss, and night sweats screened positive for TB using the symptoms screening method, while participants with a TB defining abnormality on CXR screened positive for TB by the CXR screening method. The Löwenstein-Jensen (LJ) culture was used as a gold standard for TB diagnosis. The CXR had 93% sensitivity and 65% specificity compared to LJ culture results, while symptoms had 76% sensitivity and 31% specificity. The screening algorithm involving the CXR in addition to symptoms led to a 38% increment in the yield of diagnosed tuberculosis. The number needed to screen using the CXR and symptoms screening algorithm was 32 compared to 45 when the symptoms are used alone. Therefore, the CXR in combination with symptoms is a good TB screening tool and increases the yield of diagnosed TB.

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“…Some studies included stratified analyses among multiple high-risk populations and thus contributed results to multiple categories (i.e., clinical and/or structural risk factors). Seventeen studies included persons with clinical risk factors; [ 32 , 34 , 38 ] fourteen among PLHIV, the majority of which (12/14) were conducted in Sub-Saharan Africa (SSA) [ 29 – 32 , 37 , 39 – 42 , 44 , 45 , 49 , 52 , 53 ]. Thirteen studies included persons with structural risk factors (i.e., migrants, persons experiencing homelessness, or miners) and were from a range of countries such as Belgium, Cambodia, China, Russia, South Africa, and Zimbabwe [ 11 , 32 , 33 , 35 , 36 , 38 , 43 , 46 – 48 , 51 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three studies provided cost-effectiveness data for individuals with the following clinical risk factors: diabetes mellitus, chronic respiratory disease and fibrotic lesions (Table 3 ) [ 32 , 34 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

“…Bogdanova et al assessed screening with chest X-ray (CXR) in Russia, and stratified results among diabetic patients as well as persons with other medical comorbidities (i.e., respiratory disease, gastro-intestinal, or fibrotic chest lesions); [ 32 ] reported costs ranged from US$11,648 to $105,754 per TB case diagnosed [ 32 ]. In Zimbabwe, Machekera et al found that screening diabetic patients with CXR followed by Xpert® cost US$2191 per person diagnosed with TB [ 38 ]. Ji et al reported that routine screening with CXR among Chinese patients with diabetes was considered highly cost-effective, as compared to PCF, with an ICER of US$288 per DALY averted [ 34 ].…”

Section: Resultsmentioning

confidence: 99%

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Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review

et al. 2021

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Background Systematic screening for active tuberculosis (TB) is a strategy which requires the health system to seek out individuals, rather than waiting for individuals to self-present with symptoms (i.e., passive case finding). Our review aimed to summarize the current economic evidence and understand the costs and cost-effectiveness of systematic screening approaches among high-risk groups and settings. Methods We conducted a systematic review on economic evaluations of screening for TB disease targeting persons with clinical and/or structural risk factors, such as persons living with HIV (PLHIV) or persons experiencing homelessness. We searched three databases for studies published between January 1, 2010 and February 1, 2020. Studies were included if they reported cost and a key outcome measure. Owing to considerable heterogeneity in settings and type of screening strategy, we synthesized data descriptively. Results A total of 27 articles were included in our review; 19/27 (70%) took place in high TB burden countries. Seventeen studies took place among persons with clinical risk factors, including 14 among PLHIV, while 13 studies were among persons with structural risk factors. Nine studies reported incremental cost-effectiveness ratios (ICERs) ranging from US$51 to $1980 per disability-adjusted life year (DALY) averted. Screening was most cost-effective among PLHIV. Among persons with clinical and structural risk factors there was limited evidence, but screening was generally not shown to be cost-effective. Conclusions Studies showed that screening is most likely to be cost-effective in a high TB prevalence population. Our review highlights that to reach the “missing millions” TB programmes should focus on simple, cheaper initial screening tools (i.e., symptom screen and CXR) followed by molecular diagnostic tools (i.e., Xpert®) among the highest risk groups in the local setting (i.e., PLHIV, urban slums). Programmatic costs greatly impact cost-effectiveness thus future research should provide both fixed and variable costs of screening interventions to improve comparability.

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A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe

Cited by 5 publications

References 20 publications

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

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

Accuracy and Incremental Yield of the Chest X-Ray in Screening for Tuberculosis in Uganda: A Cross-Sectional Study

Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review

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