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

Alsdurf, H.; Empringham, B.; Miller, C.; Zwerling, A.

doi:10.1186/s12879-021-06633-3

BMC Infectious Diseases

Table 4 TB Screening Algorithm Costs in PLHIV

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^,2 of the screening algorithm per person	Average cost¹^,2 of diagnosis per person
First author, Year	Country	Screening	Diagnostic Tests	Source of Unit Costs	Staff	Equipment	Consumables	Overhead	Transport	Average cost¹^,2 of the screening algorithm per person	Average cost¹^,2 of diagnosis per person
PLHIV—using molecular rapid diagnostic tests (i.e., Xpert MTB/RIF) for screening (N = 7)^a
Bassett 2010	South Africa	WHO 4SS, sputum	Xpert MTB/RIF	Reported by study	✓	✓	✓			$52 per person screened	$324 per additional TB case diagnosed
Andrews 2012	South Africa	Two Xperts for everyone	Xpert MTB/RIF	Reported by study	✓	✓	✓			$37 per person screened	$4,096 per YLS
Abimbola 2012	South Africa	WHO 4SS	Xpert MTB/RIF	Reported by study		✓	✓			$26 per person screened	$48,542 per death averted
Zwerling 2015	Malawi	WHO 4SS, Xpert	Xpert MTB/RIF	Reported by study	✓	✓	✓	✓		50 tests/year: $116 per person screened	$1,980 per DALY averted (UR: $1544-$3552)
Zwerling 2015	Malawi	WHO 4SS, Xpert	Xpert MTB/RIF	Reported by study	✓	✓	✓	✓		1000 tests/year: $18 per person screened	$398 per DALY averted (UR: $80–1682)
Adelman 2017	Ethiopia	WHO 4SS, Xpert	Xpert MTB/RIF	Reported by study	✓	✓	✓			NR	$5 per death averted
Orlando 2018	Mozambique	Screening with Xpert	Xpert MTB/RIF	Reported by study		✓	✓			$10 per person screened	$37 per DALY averted
Orlando 2018	Mozambique	CD4 count < 200 then LF-LAM	Xpert; LF-LAM	Reported by study		✓	✓			$3 per person screened	$51 per DALY averted
Reddy 2019	South Africa	Sputum/urine Xpert, TB-LAM	Xpert MTB/RIF	Calculated from study data		✓	✓			$31 per person screened* (Range: $11-$73)	$802 per YLS
Reddy 2019	Malawi	Sputum/urine Xpert, TB-LAM	Xpert MTB/RIF	Calculated from study data		✓	✓			$72 per person screened* (Range: $18-$105)	$596 per YLS
PLHIV—using CXR for screening (N = 6)^b
Shah 2008	Vietnam	Monthly home visits to PLHIV with a CXR voucher	NR	Calculated from study data	✓	✓	✓		✓	$7-$11 per person screened	$115 per TB case diagnosed
Shah 2009	Ethiopia	CXR for all PLHIV at entry to the clinic	SSM on all positive CXR	Calculated from study data		✓	✓			$6 per person screened	$106 per TB case diagnosed
Bassett 2010	South Africa	WHO 4SS, CXR	Xpert MTB/RIF	Reported by study	✓	✓	✓			$52 per person screened	$324 per additional TB case diagnosed
Mahesawaran 2012	Sub-Saharan Africa (SSA)	Symptom screen for any symptom	SSM then CXR if smear negative	Reported by study		✓	✓			$11 per person screened (Range: $10-$29)	$6,245 per QALY (UR: $6,245-$19,581)
Murray 2016	Uganda	Screening for cough, CXR triage test	Xpert MTB/RIF	Reported by study		✓	✓			$22 per person screened	$536 per YLG (UR: $176-$2,514)
Bogdanova 2019	Russian Federation	Mass CXR screening programs in PLHIV	NR	Calculated from study data	✓	✓	✓		✓	$4-$7 per person screened	$570 per TB case diagnosed
PLHIV—using CRP for screening (N = 2)^c
Murray 2016	Uganda	Screening for cough, CRP triage test	Xpert MTB/RIF	Reported by study	✓	✓				$21 per person screened	$517 per YLG (UR: $194-$1,535)
Yoon 2019	Uganda	POC CRP; TB-LAM	Xpert MTB/RIF	Calculated from study data		✓	✓			$13-$34 per person screened	$69-$92 per additional TB case diagnosed
Outpatient PLHIV—SSM only for screening (N = 1)^d
Kranzer 2012	South Africa	WHO 4SS; SSM at a mobile HIV testing clinic	SSM	Reported by study	✓	✓	✓			NR	$762 per TB case diagnosed

^aIn Sub-Saharan Africa, the average cost per person screened using rapid molecular diagnostic tests ranged from $3 to $116. Screening programs were found to be cost-effective in 6/7 (86%) of studies, with the following ICERs reported: $324 per additional TB case diagnosed; $37-$79 per DALY averted; $596–$4096 per YLS; and $517 per YLG. However, one study in Malawi found that screening with Xpert was not cost-effective at low test volumes, with an ICER of $1,980 per DALY averted. Cost-effectiveness depended on the volume of tests conducted annually and prevalence of TB
^bData was available for among outpatient PLHIV using CXR as a screening tool from six studies of good quality overall. Three studies, from South Africa, Russia and Vietnam, included health system costs as well as unit tests costs, and reported an average cost per person screened using CXR ranging from $4 to $29. Three studies in Sub-Saharan Africa reported the average cost per person screened using CXR ranged from $6 to $52. The average cost per TB case diagnosed ranged from $106-$570. Screening with CXR was shown to be cost-effective among PLHIV with ICERs of $6245 per QALY and $536 per YLS
^cLimited data was available for screening among outpatient PLHIV using CRPs from two studies both of which were of good quality. The average cost for test costs alone of outpatient PLHIV in Uganda screened using CRP with Xpert, TB-LAM and culture for diagnosis ranged from $13 to $34 per person screened and was shown to be cost-effective with an ICER of $517 per YLS or $69–$92 per additional TB case diagnosed in Uganda
^dLimited data was available from one study conducted at an HIV testing clinic in South Africa for screening using SSM alone. This study reported an average cost of $762 per TB case diagnosed at a mobile testing clinic
CRP C-reactive protein, CXR chest x-ray, mWRDs molecular WHO-approved rapid diagnostics, NR not reported, PLHIV people living with HIV, POC point-of-care, WHO 4SS, four symptom screen, Xpert GeneXpert, YLG year of life gained, YLS year of life saved
¹Costs in 2019 USD unless stated otherwise
²All costs reported in 2019 USD unless stated otherwise

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ISSN: 1471-2334

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