BACKGROUND: Passive case finding (PCF) is the strategy implemented by most developing countries to detect new cases of tuberculosis (TB), but detection rates remain low. Active case finding (ACF) is an alternative strategy, although cost is a barrier to implementation. We estimated the cost-effectiveness of a city-wide ACF programme in Kampala, Uganda, compared to the PCF strategy. METHODS: We developed a decision tree and Markov model to compare ACF vs. PCF across several outcome measures. Parameter estimates for costs, probabilities and utility scores were obtained from published reports and peer-reviewed journal articles. The main outcome measures were TB cases detected, deaths averted, life years saved (LYS) and quality-adjusted life years (QALYs). RESULTS: Our model found that ACF implemented city-wide would result in an additional 1594 TB cases detected in 1 year, 675 deaths averted over a 5-year period, 21,928 LYS, and would cost an additional US$109 per additional QALY. The 25-34 year age group received most health benefits (556 cases detected, 229 deaths averted, 8058 LYS), and the programme was most cost-effective in the 45-54 year age group (US$51/QALY). CONCLUSIONS: ACF is an effective strategy for TB control and improving quality of life and is also cost-effective.
BACKGROUND: Passive case finding (PCF) is the strategy implemented by most developing countries to detect new cases of tuberculosis (TB), but detection rates remain low. Active case finding (ACF) is an alternative strategy, although cost is a barrier to implementation. We estimated the cost-effectiveness of a city-wide ACF programme in Kampala, Uganda, compared to the PCF strategy. METHODS: We developed a decision tree and Markov model to compare ACF vs. PCF across several outcome measures. Parameter estimates for costs, probabilities and utility scores were obtained from published reports and peer-reviewed journal articles. The main outcome measures were TB cases detected, deaths averted, life years saved (LYS) and quality-adjusted life years (QALYs). RESULTS: Our model found that ACF implemented city-wide would result in an additional 1594 TB cases detected in 1 year, 675 deaths averted over a 5-year period, 21,928 LYS, and would cost an additional US$109 per additional QALY. The 25-34 year age group received most health benefits (556 cases detected, 229 deaths averted, 8058 LYS), and the programme was most cost-effective in the 45-54 year age group (US$51/QALY). CONCLUSIONS: ACF is an effective strategy for TB control and improving quality of life and is also cost-effective.
Authors: J N Sekandi; J List; H Luzze; X-P Yin; K Dobbin; P S Corso; J Oloya; A Okwera; C C Whalen Journal: Int J Tuberc Lung Dis Date: 2014-01 Impact factor: 2.373
Authors: Vladimir N Kuznetsov; Andrej M Grjibovski; Andrey O Mariandyshev; Eva Johansson; Gunnar A Bjune Journal: Int J Circumpolar Health Date: 2014-02-14 Impact factor: 1.228
Authors: Juliet N Sekandi; Kevin Dobbin; James Oloya; Alphonse Okwera; Christopher C Whalen; Phaedra S Corso Journal: PLoS One Date: 2015-02-06 Impact factor: 3.240
Authors: Nicholas Sebuliba Kirirabwa; Derrick Kimuli; Seyoum DeJene; Carol Nanziri; Estella Birabwa; Daniel Ayen Okello; Pedro Guillermo Suarez; Samuel Kasozi; Raymond Byaruhanga; Deus Lukoye Journal: PLoS One Date: 2018-12-19 Impact factor: 3.240