Abstract
This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective.
Highlights
We extended the proportion of TB deaths reported by passive case finding (PCF) in the control sites (32 deaths for 2875 TB cases (1.11%)) to approximate the TB deaths that would have occurred among the undetected TB cases in the same localities
When judged against the more conservative countryspecific cost-effectiveness threshold (USD 297), [32] active case-finding (ACF) SAR and one-off ACF models were cost-effective with probabilities 0.804 and 0.862, respectively (Supplementary Materials). This economic evaluation study found that the community-based TB ACF approaches—ACF SAR model and one-off ACF—were cost-effective
The incremental cost-effectiveness ratio (ICER) for both models are well below the GDP per capita in 2018 (USD 1643) and the country-specific costeffectiveness thresholds that were estimated by Ochalek and colleagues [32]
Summary
Cambodia was one of the world’s 30 high tuberculosis (TB)-burden countries, with an estimated incidence of active TB of 274 (95% confidence interval [CI]: 177–392) per. 100,000 population in 2020 [1]. The incidence of TB has gradually declined over the past two decades, along with improvement in TB treatment success rates and a reduction in TB-related mortality [2,3]. To fight TB, Cambodia has established an infrastructure network of TB service provision consisting of 100 district and referral hospitals and over 1140 health centers embedded in the national healthcare system [4]. The national TB program (NTP), led by the National Center for Tuberculosis and Leprosy Control (CENAT), works
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