Cost-effectiveness analysis with surrogate endpoint: mobile targeted active case detection for early detection of tuberculosis

Abstract

Abstract Objective This study aimed to determine cost-effectiveness analysis with the surrogate endpoint of mobile targeted active case detection (MTACD) programmes in the early detection of tuberculosis (TB) cases. Methods A cross-sectional study to determine the cost-effectiveness with the surrogate endpoint of MTACD as compared with passive case detection (PCD) from the provider’s perspective. Data were gathered on the costs and significant dates (TB screening date, first TB symptoms date, TB diagnosis date, and TB treatment starting date) for 904 patients from five Sabah districts in 2022. A combined step-down and activity-based costing method was used to estimate provider costs. The health outcome measures used were the time taken by the day to detect TB cases. Cost-effectiveness analysis with surrogate endpoint was assessed using cost per TB screening by MTACD and PCD, and the mean of the time taken by the day to detect TB cases. Key findings The total cost for a patient to be screened by MTACD was Malaysian Ringgit (MYR) 96.6 (MYR 1 = USD 0.22), while the cost by PCD was MYR 43.1. The MTACD generally costs MYR 1727.1 to detect a case of TB, compared with MYR 586.9 for PCD. However, MTACD used a shorter mean time to detect TB cases (52.7 days) than PCD (98.9 days). Conclusions Despite the higher costs per screening, MTACD may shorten the days of diagnosis from the onset of TB symptoms when compared with PCD. This study is beneficial when budgeting for TB programmes since MTACD can detect TB cases earlier and lead to early treatment.