title: Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation.
abstract: OBJECTIVE
  To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis.
  
  
  METHODS
  Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis.
  
  
  METHODS
  London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London's enhanced tuberculosis surveillance system.
  
  
  METHODS
  Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service.
  
  
  RESULTS
  The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10,000/QALY gained (about €7300-€11,000 or $10,000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18,000-£26,000/QALY gained; case management support team, £4100-£6800/QALY gained).
  
  
  CONCLUSIONS
  Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance.
authors: Health Protection Agency, London NW9 5EQ, UK.
authors: Mark
authors: M
authors: Jit
authors: Helen R
authors: HR
authors: Stagg
authors: Robert W
authors: RW
authors: Aldridge
authors: Peter J
authors: PJ
authors: White
authors: Ibrahim
authors: I
authors: Abubakar
mesh_terms: D000995:Antitubercular Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D008131:London; D008403:Mass Screening / Q000191:economics; D008952:Mobile Health Units / Q000191:economics*; D019370:Observation; D015397:Program Evaluation; D011788:Quality of Life; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*
chemical_list: D000995:Antitubercular Agents