背景:大多数发展中国家实施的标准被动病例发现策略不足以发现新的结核病例。家庭接触调查是一种替代方法。然而,支持中低收入国家规划和实施的成本效益数据有限。该研究旨在评估在乌干达西南部结核病控制计划中将家庭接触调查(HCI)添加到被动病例发现(PCF)策略中的成本效益。
方法:我们使用回顾性研究方法和自下而上的成本计算(成分)技术进行了经济评估。这是对从地区卫生信息系统(DHIS2)中提取的现有数据的综合评估,TB寄存器,和主要成本调查。该研究比较了结核病(TB)病例发现的两种方法(PCF和HCI)策略。关于PCF,患者要么自我报告他们的体征和症状,要么由医护人员提示.同时,HCI是通过家访和筛查结核病患者的接触者来完成的。假定患有结核病的患者和家庭接触者被要求提供样品进行分析。我们应用了静态决策分析建模框架来检查这两种策略的成本和有效性。该研究依赖于国家结核病(TB)计划数据的成本和概率估计,活动成本,出版文献。它是从社会和提供者的角度在Ntungamo的12个设施中进行了1.5年,Sheema,和Rwampara地区。主要有效性测量是检测到的TB病例数(产量)和筛查所需的数量(NNS)。从研究期间筛选的患者数量计算TB产量。增量成本效益比(ICER)表示为2021年每检测到额外结核病病例的成本美元。由于分析时间很短,我们没有采用贴现率。
结果:检测结核病病例的单位成本为PCF的204.22美元(美元)和HCI的315.07美元。PCF的患者和护理人员费用是HCI的五倍[26.37美元。5.42美元]。每检测到额外的结核病病例,ICER为3,596.94美元。被动病例发现的结核病筛查率为0.52%(1496/289140),家庭接触调查的结核病筛查率为5.8%(197/3414)。0-14岁儿童家庭接触调查收益率。15年以上[6.2%Vs.4%]P=0.04。艾滋病毒感染者(PLHIV)的产量与。HHCI中HIV阴性[15.8%Vs.5.3%]P=0.03。男性的PCF产量。女性[1.12%Vs.0.28%]P<0.01。PCF中的NNS为193[95%CI:186-294]和HCI中的17[95%CI:14-22]。
结论:我们的基线假设和在非洲农村环境中将HCI添加到现有PCF计划中的具体实现被证明是不具成本效益的,而不是HCI作为一种战略。HCI有效地识别出患有结核病的儿童和PLHIV,应优先考虑。同时,被动病例发现策略有效地发现了患有结核病的男性,并且费用低于家庭接触调查。
BACKGROUND: The standard passive
case-finding strategy implemented by most developing countries is inadequate to detect new cases of Tuberculosis. A household contact investigation is an alternative approach. However, there is limited cost-effectiveness data to support planning and implementation in low and middle-income countries. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HCI) to the passive case-finding (PCF) strategy in the Tuberculosis control program in Southwestern Uganda.
METHODS: We conducted an economic evaluation using a retrospective study approach and bottom-up costing (ingredients) techniques. It was a synthesis-based evaluation of existing data extracted from the District Health Information System (DHIS 2), TB registers, and a primary cost survey. The study compared two methods of Tuberculosis (TB)
case finding (PCF and HCI) strategies. Regarding PCF, patients either self-reported their signs and symptoms or were prompted by healthcare workers. At the same time, HCI was done by home visiting and screening contacts of TB patients. Patients and household contacts presumed to have Tuberculosis were requested to produce samples for analysis. We applied a static decision-analytic modeling framework to examine both strategies\' costs and effectiveness. The study relied on cost and probability estimates from National Tuberculosis (TB) program data, activity costs, and published literature. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntungamo, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients screened during the period under study. The incremental cost-effectiveness ratio (ICER) was expressed as cost in 2021 US$ per additional TB
case detected. We did not apply a discount rate because of the short analytic time horizon.
RESULTS: The unit costs of detecting a Tuberculosis
case were US$ (United States dollar) 204.22 for PCF and US$ 315.07 for HCI. Patient and caregiver costs are five times more in PCF than in HCI [US$26.37 Vs. US$ 5.42]. The ICER was US$ 3,596.94 per additional TB
case detected. The TB screening yields were 0.52% (1496/289140) for passive case finding and 5.8% (197/3414) for household contact investigation. Household contact investigation yield among children 0-14 Vs. 15+ years [6.2% Vs.5.4%] P = 0.04. The Yield among People living with HIV (PLHIV) Vs. HIV-negative [15.8% Vs.5.3%] P = 0.03 in HHCI. The PCF yield in men Vs. Women [1.12% Vs.0.28%] P<0.01. The NNS in PCF was 193 [95% CI: 186-294] and 17 [95% CI: 14-22] in HCI.
CONCLUSIONS: Our baseline assumptions and the specific implementations of adding HCI to existing PCF programs in the context of rural African settings prove to be not cost-effective, rather than HCI as a strategy. HCI effectively identifies children and PLHIV with TB and should be prioritized. Meanwhile, the Passive case-finding strategy effectively finds men with TB and costs lower than household contact investigation.