A systematic review of economic models used to assess the cost-effectiveness of strategies for identifying latent tuberculosis in high-risk groups

Auguste, Peter; Tsertsvadze, Alexander; Court, Rachel; Pink, Joshua

doi:10.1016/j.tube.2016.04.007

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…An approach entailing IGRA testing, though being clearly preferrable over TST, would have been rather unrealistic in our case due to its high cost and logistical challenges [28,29]. Introduction of IGRA, though to a lesser extent than TST, would have also led to diagnosis of a number of LTBI cases, all needing treatment and regular follow-up.…”

Section: Discussionmentioning

confidence: 90%

Active case finding of pulmonary TB in a European refugee camp: lessons learnt from Oinofyta hosting site in Greece

Solomos¹,

Botsi

Georgakopoulou

et al. 2021

Tropical Med Int Health

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objectives To report on an active case finding (ACF) intervention that took place in the migrant camp of Oinofyta, Greece, upon suspicion of active TB transmission. methods Upon diagnosis of 3 TB cases among camp residents, an ACF intervention among contacts was implemented. All camp residents were offered two-step screening, that is tuberculin skin testing (TST) followed by chest X-ray in case of positive TST (defined as ≥5 mm). results 336 of 379 (89%) camp residents underwent TST testing, of whom 110 (33%) exhibited a positive skin reaction. The rate of positive TST results was particularly high in the elderly and significantly higher in adults than in children. Differences by sex or nationality were not observed. Of the 110 cases with positive TST, only 75 underwent chest X-ray, resulting in the detection of one pulmonary TB case in an adult woman. conclusions In the given intervention context, two-step ACF proved to be operationally cumbersome, with many residents lost to follow-up and a high Number Needed to Screen. Simpler ACF designs should be pilot-tested in similar settings in the future, and blanket screening of all camp residents should be reconsidered. Conclusions drawn by these exercises should pave the way for adopting a comprehensive, context-specific and evidence-based national strategy on TB in migrants.

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Section: Discussionmentioning

confidence: 90%

Active case finding of pulmonary TB in a European refugee camp: lessons learnt from Oinofyta hosting site in Greece

Solomos¹,

Botsi

Georgakopoulou

et al. 2021

Tropical Med Int Health

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“…The included studies were also afflicted by quality issues pertaining to structural approaches identified by a previous review, such as failure to address structural uncertainty. [ 12 ] In addition, the studies also showed extensive disparities in the structural approaches.…”

Section: Discussionmentioning

confidence: 99%

“…A more recent systematic review described various structure of models used to predict the cost-effectiveness of TB screening strategies and addressed their quality. [ 12 ] Although it highlighted the influence of several parameters, such as tool’s accuracy, it did not analyze the potential influence of different structural approaches on the cost-effectiveness estimates. [ 12 ] As shown by studies in other disease areas, models’ structural approaches disparities, such as different choices of health states (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…[ 12 ] Although it highlighted the influence of several parameters, such as tool’s accuracy, it did not analyze the potential influence of different structural approaches on the cost-effectiveness estimates. [ 12 ] As shown by studies in other disease areas, models’ structural approaches disparities, such as different choices of health states (e.g. inclusion or exclusion of latent disease state), may substantially influence cost-effectiveness results.…”

Section: Introductionmentioning

confidence: 99%

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Disparities in model-based cost-effectiveness analyses of tuberculosis diagnosis: A systematic review

et al. 2018

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BackgroundStructural approach disparities were minimally addressed in past systematic reviews of model-based cost-effectiveness analyses addressing Tuberculosis management strategies. This review aimed to identify the structural approach disparities in model-based cost-effectiveness analysis studies addressing Tuberculosis diagnosis and describe potential hazards caused by those disparities.MethodsA systematic search to identify studies published before October 2015 was performed in five electronic databases. After removal of duplication, studies’ titles and abstracts were screened based on predetermined criteria. The full texts of potentially relevant studies were subsequently screened and excluded when they did not address active pulmonary Tuberculosis diagnosis. Quality of the studies was assessed using the “Philips’ checklist.” Various data regarding general information, cost-effectiveness results, and disease modeling were extracted using standardized data extraction forms. Data pertaining to models’ structural approaches were compared and analyzed qualitatively for their applicability in various study settings, as well as their potential influence on main outcomes and cost-effectiveness conclusion.ResultsA total of 27 studies were included in the review. Most studies utilized a static model, which could underestimate the cost-effectiveness of the diagnostic tools strategies, due to the omission of indirect diagnosis effects, i.e. transmission reduction. A few structural assumption disparities were found in the dynamic models. Extensive disparities were found in the static models, consisting of varying structural assumptions regarding treatment outcomes, clinical diagnosis and empirical treatment, inpatient discharge decision, and re-diagnosis of false negative patients.ConclusionIn cost-effectiveness analysis studies addressing active pulmonary Tuberculosis diagnosis, models showed numerous disparities in their structural approaches. Several structural approaches could be inapplicable in certain settings. Furthermore, they could contribute to under- or overestimation of the cost-effectiveness of the diagnosis tools or strategies. They could thus lead to ambiguities and difficulties when interpreting a study result. A set of recommendations is proposed to manage issues related to these structural disparities.

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“…These limitations notwithstanding, decision-tree models have been widely applied to inform decisionmaking in multiple settings, such as treatment of rheumatoid arthritis [134], diagnosis of latent tuberculosis infection [135], and health interventions for drug and alcohol problems [136]. …”

Section: Decision-tree Modelsmentioning

confidence: 99%

Using novel biomarkers to triage young adult women with minor cervical lesions: a cost‐effectiveness analysis

Pedersen

Sørbye

et al. 2016

BJOG

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Objective To evaluate the short‐term consequences and cost‐effectiveness associated with the use of novel biomarkers to triage young adult women with minor cervical cytological lesions. Design Model‐based economic evaluation using primary epidemiological data from Norway, supplemented with data from European and American clinical trials. Setting Organised cervical cancer screening in Norway. Population Women aged 25–33 years with minor cervical cytological lesions detected at their primary screening test. Methods We expanded an existing simulation model to compare 12 triage strategies involving alternative biomarkers (i.e. reflex human papillomavirus (HPV) DNA/mRNA testing, genotyping, and dual staining) with the current Norwegian triage guidelines. Main outcome measures The number of high‐grade precancers detected and resource use (e.g. monetary costs and colposcopy referrals) for a single screening round (3 years) for each triage strategy. Cost‐efficiency, defined as the additional cost per additional precancer detected of each strategy compared with the next most costly strategy. Results Five strategies were identified as cost‐efficient, and are projected to increase the precancer detection rate between 18 and 57%, compared with current guidelines; however, the strategies did not uniformly require additional resources. Strategies involving HPV mRNA testing required fewer resources, whereas HPV DNA‐based strategies detected >50% more precancers, but were more costly and required twice as many colposcopy referrals compared with the current guidelines. Conclusion Strategies involving biomarkers to triage younger women with minor cervical cytological lesions have the potential to detect additional precancers, yet the optimal strategy depends on the resources available as well as decision‐makers' and women's acceptance of additional screening procedures. Tweetable abstract Women with minor cervical lesions may be triaged more accurately and effectively using novel biomarkers.

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A systematic review of economic models used to assess the cost-effectiveness of strategies for identifying latent tuberculosis in high-risk groups

Abstract: Background

Cited by 13 publications

References 19 publications

Active case finding of pulmonary TB in a European refugee camp: lessons learnt from Oinofyta hosting site in Greece

Active case finding of pulmonary TB in a European refugee camp: lessons learnt from Oinofyta hosting site in Greece

Disparities in model-based cost-effectiveness analyses of tuberculosis diagnosis: A systematic review

Using novel biomarkers to triage young adult women with minor cervical lesions: a cost‐effectiveness analysis

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