How much does TB screening cost? A systematic review of economic evaluations

Author:

Empringham B.1,Alsdurf H.2,Miller C.3,Zwerling A.2

Affiliation:

1. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada, Children´s Hospital of Eastern Ontario, Ottawa, ON, Canada

2. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

3. Global TB Programme, World Health Organization, Geneva, Switzerland

Abstract

BACKGROUND: Systematic screening for TB has been recommended as a method to control TB on a global level; however, this involves significant costs that place a burden on the health system.METHODS: We conducted a systematic review of the existing economic literature on systematic screening for TB to summarise costs, cost-effectiveness and affordability, and the key factors that influence costs and cost-effectiveness. Specific populations of interest included the general population, children and close contacts of TB patients.RESULTS: We identified 21 studies that provided both cost and outcome data on TB screening among the populations of interest. All were from low- and middle-income settings. Studies were heterogenous in the intervention, and included costs and reported outcomes. The incremental cost-effectiveness ratio (ICER) estimates ranged from USD281 to USD698 per disability-adjusted life-year (DALY) averted among the general population, USD619/DALY averted among children and USD372–3,718/DALY averted among close contacts.CONCLUSION: Prevalence of TB among targeted high-risk groups was identified across the majority of studies as a driver of cost-effectiveness. The heterogeneity of the included costs and outcomes across the economic literature for systematic screening suggests a need for standardisation of included cost components and key economic evaluation methods to improve comparability and generalisability of results.

Publisher

International Union Against Tuberculosis and Lung Disease

Subject

Infectious Diseases,Pulmonary and Respiratory Medicine

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