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Comparative assessment of the cost-effectiveness of Tuberculosis (TB) active case-finding interventions: A systematic analysis of TB REACH wave 5 projects.
Gomes, Isabella; Dong, Chaoran; Vandewalle, Pauline; Khan, Amera; Creswell, Jacob; Dowdy, David; Sohn, Hojoon.
  • Gomes I; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
  • Dong C; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
  • Vandewalle P; Stop TB Partnership, TB REACH Initiative, Geneva, Switzerland.
  • Khan A; Stop TB Partnership, TB REACH Initiative, Geneva, Switzerland.
  • Creswell J; Stop TB Partnership, TB REACH Initiative, Geneva, Switzerland.
  • Dowdy D; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
  • Sohn H; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
PLoS One ; 17(9): e0270816, 2022.
Article in English | MEDLINE | ID: covidwho-2054312
ABSTRACT

PURPOSE:

Interventions that can help streamline and reduce gaps in the tuberculosis (TB) care cascade can play crucial roles in TB prevention and care, but are often operationally complex and resource intensive, given the heterogenous settings in which they are implemented. In this study, we present a comparative analysis on cost-effectiveness of TB REACH Wave 5 projects with diverse programmatic objectives to inform future decisions regarding funding, strategic adoption, and scale-up.

METHODS:

We comprehensively reviewed project reports and financial statements from TB REACH Wave 5, a funding mechanism for interventions that aimed to strengthen the TB care cascade in diverse settings. Two independent reviewers abstracted cost (in 2017 US dollars) and key programmatic data, including project type (case-finding only; case-finding and linkage-to-care; or case-finding, linkage-to-care and patient support), operational setting (urban or rural), and project outputs (numbers of people with TB diagnosed, started on treatment, and successfully completing treatment). Cost-effectiveness ratios for each project were calculated as ratios of apportioned programmatic expenditures to corresponding project outputs.

RESULTS:

Of 32 case finding and patient support projects funded through TB REACH Wave 5, 29 were included for analysis (11 case-finding only; 9 case-finding and linkage-to-care; and 9 case-finding, linkage-to-care and patient support). 21 projects (72%) were implemented in either Africa or Southeast Asia, and 19 (66%) focused on serving urban areas. Average cost-effectiveness was $184 per case diagnosed (range $30-$10,497), $332 per diagnosis and treatment initiation ($123-$10,608), and $40 per patient treatment supported ($8-$160). Cost per case diagnosed was lower for case-finding-only projects ($132) than projects including linkage-to-care ($342) or linkage-to-care and patient support ($254), and generally increased with the corresponding country's per-capita GDP ($543 per $1000 increase, 95% confidence interval -$53, $1138).

CONCLUSION:

The costs and cost-effectiveness of interventions to strengthen the TB care cascade were heterogenous, reflecting differences in context and programmatic objective. Nevertheless, many such interventions are likely to offer good value for money. Systematic collection and analysis of cost-effectiveness data can help improve comparability, monitoring, and evaluation.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis Type of study: Diagnostic study / Experimental Studies / Observational study / Systematic review/Meta Analysis Limits: Humans Country/Region as subject: Africa Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0270816

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis Type of study: Diagnostic study / Experimental Studies / Observational study / Systematic review/Meta Analysis Limits: Humans Country/Region as subject: Africa Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0270816