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allied
academies
September 20-21, 2017 | Philadelphia, USA
Global summit on
TUBERCULOSIS AND LUNG DISEASE
Int J Respir Med 2017 Volume 2 Issue 2
Introduction:
Tuberculosis (TB) is a major global health risk in Sub-Saharan Africa.
Passive Case Finding (PCF) is limited due to delays in case detection. Active case finding
(ACF) strategies including Household Contact Investigation (HCI) and Enhanced Case
Finding (ECF) have been alternatively proposed to improve TB case detection, but
little is known about their cost-effectiveness. We assessed the cost-effectiveness of
PCF+ECF+HCI combination compared to PCF only for TB case detection among high-risk
communities in Kampala from provider’s perspective.
Methods:
Data on costs and yield of TB cases for PCF only and a combination of
PCF+ECF+HCI was collected among adults in highly-congested areas of Kampala
over 12 months. Costs were adjusted to US$ for the 2015 annual average. The main
outcome was the Incremental Cost Effectiveness Ratio (ICER) representing the cost to
detect an additional TB case. The decision threshold used was three times Uganda’s
GDP (US$ 2089). One-way sensitivity analysis was done to assess uncertainty of the
ICER around key variables.
Results:
Based on Uganda TB program data, 4,755 pulmonary TB cases from 12,298
presumptive TB cases were identified through PCF alone. PCF+ECF+HCI combination
yielded 5,120 cases from 12,915 presumptive cases. The average cost per patient for
PCF and PCF+HCI+ECF was US$ 895.8 and US$ 4909.9 respectively. The cost of detecting
one additional TB case was US$ 8211.8 using PCF+ECF+HCI compared to using PCF only.
In one-way sensitivity analyses, the ICER was most sensitive to number of household
contacts screened, number of TB cases identified through ECF and probability of having
chronic cough.
Conclusion:
From the provider’s perspective, PCF+ECF+HCI was costlier and had
a marginally higher yield of TB cases than PCF only, but it was not a cost-effective
strategy. In settings with minimal resources, low-cost approaches to improving
household contact screening and enhanced case finding might add value to passive
TB case detection.
e:
assebagereka@gmail.comA cost effectiveness analysis of pulmonary tuberculosis case finding strategies among high risk
communities in Kampala, Uganda
Anthony Ssebagereka
1
, Stevens Kisaka
1
and
Juliet Sekandi
2
1
Makerere university School of Public Health, Uganda
2
University of Georgia, USA