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

SETTING: Guidelines regarding household contact tracing for pulmonary tuberculosis (TB) in different countries vary according to case detection methods.
OBJECTIVE: To compare costs spent on detecting one TB case among household contacts between different contact tracing strategies in Mandalay City, Myanmar.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: The interventional model was more cost-effective in detecting one more pulmonary TB case among household contacts than the modified conventional model.