Determining the value of TB active case-finding: current evidence and methodological considerations

Abstract

Active case-finding (ACF) is an important component of the End TB Strategy. However, ACF is resource-intensive, and the economics of ACF are not well-understood. Data on the costs of ACF are limited, with little consistency in the units and methods used to estimate and report costs. Mathematical models to forecast the long-term effects of ACF require empirical measurements of the yield, timing and costs of case detection. Pragmatic trials offer an opportunity to assess the cost-effectiveness of ACF interventions within a ‘real-world´ context. However, such analyses generally require early introduction of economic evaluations to enable prospective data collection on resource requirements. Closing the global case-detection gap will require substantial additional resources, including continued investment in innovative technologies. Research is essential to the optimal implementation, cost-effectiveness, and affordability of ACF in high-burden settings. To assess the value of ACF, we must prioritize the collection of high-quality data regarding costs and effectiveness, and link those data to analytical models that are adapted to local settings.

Comparative assessment of the cost-effectiveness of Tuberculosis (TB) active case-finding interventions: A systematic analysis of TB REACH wave 5 projects

“…In this regard, our results may be an under-estimate of real-world human resource costs of ACF interventions. These data limitations in our study shed light on the need to improve and standardize the types and depth of the data necessary to perform comparative in-depth empiric cost and cost-effectiveness assessment of ACF interventions [ 9 , 14 , 15 ]. In particular, the cost per person screened (or initiating treatment) is also useful to programs for budgeting purposes and should be a priority for future research.…”

“…However, as described in our study, ACF projects are becoming more diversified to address gaps in the complex TB care cascade that are specific to the needs in the settings where these projects are implemented. Therefore, more detailed evaluation that includes projection of future benefits of key programmatic components (e.g., TPT provision to contacts of TB patients identified through ACF interventions or treatment linkages and adherence programs) is needed for each individual projects to precisely estimate the overall value and incremental cost-effectiveness of ACF interventions in each context [6,7,[15][16][17][18].…”

Long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands

“…Therefore, the extent of the diffusion of the interventions' effects between the different locations relies on our assumption that 95% of interpersonal contacts occur between individuals of the same geographical stratum. Finally, we stress that the projections presented in this study are intended to be primarily relevant to the RMI context and, given the variability of TB epidemics in different settings, drawing quantitative conclusions for other settings would require dedicated analyses (20).…”

A spatial analysis of TB cases and abnormal X-rays detected through active case-finding in Karachi, Pakistan

“…The capacity for ACF has been significantly strengthened in Pakistan through capital investments for mobile X-rays vans by NTP and its private-sector implementation partners 5 . However, concerns remain regarding their yields and cost-effectiveness 6 . As with any health-related intervention, TB programs in high burden countries such as Pakistan must rationalize costs given many competing priorities, and therefore tools and approaches to improve the efficiency of ACF interventions are particularly useful 2 .…”