A cost effectiveness analysis of active case finding and passive case finding for case detection of TB at Kisugu Health Center III, Kampala, Uganda

Abstract

Background: Case detection is an important aspect of the TB control strategy recommended by the WHO. Case detection rate remains as low as 55% amidst increasing TB cases in urban centers. This study therefore aimed at determining the cost effectiveness of active case finding (ACF) and passive case finding (PCF) in detecting TB cases. Methods and materials: This was a cross sectional study design from the provider's perspective carried out between September 2018 and February 2019. Data on costs and yield of TB cases for PCF and ACF was collected among adults aged 15–49 years at Kisugu HC III located in highly-congested and urban setting in Kampala district, Uganda. Costs were adjusted to US$ for the 2015 annual average. Capital Assets were annualized. Incremental cost effectiveness ratio (ICER) represented the cost to detect an additional TB case and decision threshold based on Uganda's GDP (US$ 2089). One- and two-way sensitivity analyses were done to assess uncertainty of the ICER around key variables. Results: The unit cost of detecting a TB case was $8.14 and $7.01 under ACF and PCF respectively. After sensitivity analyses, ACF was not cost effective. ACF was less effective yet more costly in detecting TB cases who presented with chronic cough. PCF was more effective and less costly. The incremental cost of detecting an additional case of TB under ACF was $1.13 with an incremental effectiveness ratio of −0.41. Conclusion: In an African city context, ACF is not cost effective compared to PCF. ACF provided a less number of T.B cases detected yet it was more costly compared to PCF. Note that patients who present to the health facilities (with symptoms) have a high chance of having TB. Therefore, implementation of PCF as a part of the recommended TB control strategy should be prioritized. Other low cost strategies like Household Contact investigation need to be used in complementary.