Cost-effectiveness of active case-finding of household contacts of pulmonary tuberculosis patients in a low HIV, tuberculosis-endemic urban area of Lima, Peru.
We compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.
Department of Epidemiology,Biostatistics & Occupational Health,McGill University,Montreal,Quebec,Canada.
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L
Shah
Red de Salud de San Juan de Lurigancho,Dirección de Salud Lima IV Este,Ministerio de Salud,Lima,Perú.
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M
Rojas
Red de Salud de San Juan de Lurigancho,Dirección de Salud Lima IV Este,Ministerio de Salud,Lima,Perú.
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O
Mori
Instituto de Medicina Tropical Alexander von Humboldt,Universidad Peruana Cayetano Heredia,Lima,Perú.
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C
Zamudio
Department of Epidemiology,Biostatistics & Occupational Health,McGill University,Montreal,Quebec,Canada.
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JS
Kaufman
Instituto de Medicina Tropical Alexander von Humboldt,Universidad Peruana Cayetano Heredia,Lima,Perú.
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L
Otero
Instituto de Medicina Tropical Alexander von Humboldt,Universidad Peruana Cayetano Heredia,Lima,Perú.
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E
Gotuzzo
Instituto de Medicina Tropical Alexander von Humboldt,Universidad Peruana Cayetano Heredia,Lima,Perú.
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C
Seas
Department of Medicine,David Geffen School of Medicine,University of California,Los Angeles,CA,USA.
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TF
Brewer
D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods*; D019353:Endemic Diseases; D005191:Family Characteristics; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D010568:Peru / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology
Case-finding; community epidemics; cost-effectiveness; public health; tuberculosis (TB)