Cost-Effectiveness Analysis of High-Risk Groups Tuberculosis Screening in Malaysia

Abstract

Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.

A symptomatic approach to tuberculosis screening for high-risk groups in Malaysia: Cost-effectiveness and budget impact analysis

“…Hence, not suitable for comparison purposes. Nonetheless, few studies used the number of TB cases detected as their effectiveness measure [7] , [19] , [36] . Using general effectiveness measures such as TB cases detected may not reflect the true burden of the disease.…”

“…This paper is a subset to the study on CEA of High-Risk Groups Tuberculosis Screening in Malaysia, which aimed to measure the relative cost-effectiveness and estimates the five years budget impact of symptomatic TB screening compared to the existing approach [19] . To answer the study objective, two hypotheses scenario were developed, namely existing approach and symptomatic approach.…”

“…Costs data were valued in year 2018 using Malaysia Ringgit (MYR). The Willingness to Pay (WTP) threshold of three times GDP per capita was used [19] , [20] , [21] . Based on 2018 Malaysia GDP per capita of ∼ MYR 40,000, WTP threshold was capped at MYR120,000, where MYR 1.00 ∼ USD 0.25 [22] , [23] .…”