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Table 3 TB screening algorithm costs among persons with clinical and structural risk factors

From: Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review

First author, Year

Country

Screening algorithm

Source of unit costs

Type of unit costs

Average cost1 of screening per person

Average cost1 of diagnosis per person

Screening

Diagnostic tests

Staff

Equipment

Consumables

Overhead

Transport

TB Treatment

Persons with structural risk factors (N = 16)a

 Migrants, refugees, internally displaced persons (IDPs)

  Bogdanova 2019

Russia

Mass CXR screening

SSM

Reported

   

$4 per migrant screened

$834 per TB case diagnosed

  Smit 2017

Belgium

WHO 4SS, CXR

NR

Calculated

 

   

$18 per migrant screened

$506,025 per migrant diagnosed with TB

NR

$6721 per asylum seeker diagnosed with TB

 Homeless persons and intravenous drug users (IDUs)

  Bogdanova 2019

Russia

Mass CXR screening

SSM

Reported

   

$4-$13

$793 per TB case diagnosed

  Jit 2011

United Kingdom

Mobile CXR screening for IDUs and homeless

NR

Reported

 

NR

$9837 per QALY gained

(UR: $6,302-$27,666)

 Persons who live in urban slums

  Sekandi 2015

Uganda

WHO 4SS for all HHC

SSM and

CXR

Reported

 

 

NR

$1371 per additional TB case diagnosed

  Shah 2017

Peru

Household visits for WHO 4SS for all HHC

Xpert MTB/RIF

Reported

$32 per person screened

$3244 per DALY averted

  James 2017

Cambodia

Door-to-door WHO 4SS

SSM and Xpert

Reported

 

 

 

NR

$268 per TB case diagnosed

 Members of tribal or indigenous populations

  Sohn 2019

India

Household visits for TB education and screening

SSM

Reported

  

 

< $1 per person screened

$3–5 per TB case diagnosed

 Persons residing in prisons

  Machekera 2019

Zimbabwe

WHO 4SS, CXR

Xpert MTB/RIF

Calculated

 

   

$14 per person screened

$460 per TB case diagnosed

  Smit 2017

Belgium

WHO 4SS, CXR

NR

Calculated

 

   

$18 per person screened

$14,034 per TB case diagnosed

  Winetsky 2012

Former Soviet Union

WHO 4SS alone

NR

Reported

  

$3 per person screened

$538 per QALY gained

MMR (CXR)

NR

Reported

  

$5 per person screened

Xpert MTB/RIF

NR

Reported

  

$2 per person screened

  Zishiri 2014

South Africa

WHO 4SS

Xpert MTB/RIF

Reported

 

$33 per person screened

$1423 TB case diagnosed

 Elderly (55 +)

  Jo 2020

Cambodia (> 55)

Symptom screen

Xpert, SSM, CXR

Reported

 

< $1 per person screened

$406 per TB case diagnosed

  James 2017

Cambodia (> 55)

Symptom screen

Xpert, CXR

Calculated

  

< $2 per person screened

$340 per TB case diagnosed

  Zhang 2017

China (> 65)

Door-to-door symptom screen or CXR

CXR, SSM, culture

Reported

  

NR

$74–$315 per TB case diagnosed

 People living in areas with limited access to healthcare (remote, isolated, hard-to-reach areas)

  Karki 2017

Papua New Guinea

Community-wide symptom screening

SSM

Reported

 

 

 

NR

$158 per TB case diagnosed

  Jo 2020

Cambodia

Symptom screen

Xpert, SSM, CXR

Reported

 

< $1 per person screened

$406 per TB case diagnosed

 Miners (i.e., workers with silica exposure)

  Machekera 2019

Zimbabwe

WHO 4SS, CXR

Xpert MTB/RIF

Calculated

 

   

$14 per person screened

$404 per miner diagnosed

Persons with clinical risk factors (N = 3)b

 Diabetes mellitus

  Bogdonova 2019

Russia

CXR

SSM

Reported

 

 

 

NR

$21,780 per TB case diagnosed

  Ji 2020

China

CXR

SSM

Calculated

 

 

 < $2 per person screened

$288 per DALY averted

  Machekera 2019

Zimbabwe

CXR

Xpert

Reported

   

NR

$2191 per TB case diagnosed

 Respiratory disease

  Bogdonova 2019

Russia

CXR

SSM

Reported

 

 

 

NR

$32,746 per TB case diagnosed

 Gastro-intestinal, genito-urinary, steroid use or fibrotic chest lesions

  Bogdonova 2019

Russia

CXR

SSM

Reported

 

 

 

NR

$11,648-$105,754 per TB case diagnosed

  1. aThere is limited evidence on screening among persons with structural risk factors, including migrants (n = 2), homeless persons and IDUs (n = 2), persons who live in urban slums (n = 3), members of tribal or indigenous populations (n = 1), persons residing in prisons (4), elderly (3), people living in remote areas (n = 2) and miners (1). The costs of screening among persons with structural risk factors ranged from $1–33 per person screened and $3–$506,025 per TB case diagnosed. Screening programs were found to be cost-effective in persons living in urban slums and homeless, with reported ICERs of $3244 per DALY averted and $9837 per QALY, respectively. Screening was not shown to be cost-effective in migrants with an of ICER $506,025 per migrant diagnosed. In the Former Soviet Union, screening persons residing in prisons was found to be cost-effective with an ICER of $538 per QALY gained. Door-to-door screening of the elderly in China was shown to be cost-effective with ICERs ranging from US$74 to $315 per additional TB patient diagnosed
  2. bThere is limited evidence on screening among persons with clinical risk factors, primarily from one study in Russia. One study in Russia demonstrated a cost ranging from $11,648 to $105,754 for systematic screening among persons with various clinical risk factors (i.e., gastro-intestinal, respiratory disease, genito-urinary, steroid use and fibrotic chest lesions). Two studies conducted in Russia and Zimbabwe reported the cost per person diagnosed with diabetes mellitus (DM) which ranged from $2191 to $21,780. A cost-effectiveness analysis of patients with DM in China found systematic screening using CXR was cost-effective with an ICER of $288 per DALY averted
  3. ACF active case finding, HHC household contacts, SSM sputum smear microscopy, Xpert GeneXpert, WHO 4SS four symptom screen, mWRDs molecular WHO-approved rapid diagnostics, CXR chest x-ray, NR not reported
  4. 1Costs in 2019 USD unless stated otherwise
  5. indicates cost component was explicitly included in unit cost calculation