Cost-effectiveness of a new strategy to detect pulmonary tuberculosis in household contacts in Myanmar.

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Guidelines regarding household contact tracing for pulmonary tuberculosis (TB) in different countries vary according to case detection methods. To compare costs spent on detecting one TB case among household contacts between different contact tracing strategies in Mandalay City, Myanmar. Cost estimation of case detection and diagnostic procedures using two different strategies were calculated. A modified conventional model included screening for TB signs and symptoms, sputum examination for those with positive signs and symptoms and chest X-ray (CXR) for those with negative sputum results. An interventional model included CXR, sputum examination if CXR was abnormal and Xpert® MTB/RIF assay for those with negative sputum results. Estimated costs in each model were stratified by age <15 and 15 years. The additional cost per TB case detected using the interventional model was US$35.41 compared to the modified conventional model. The probability that the interventional model was cost-effective using a threshold of US$100 per case detected was 81% (83% for those aged 15 years and 65% for those aged <15 years). The interventional model was more cost-effective in detecting one more pulmonary TB case among household contacts than the modified conventional model.