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How much does TB screening cost? A systematic review of economic evaluations

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BACKGROUND: Systematic screening for TB has been recommended as a method to control TB on a global level; however, this involves significant costs that place a burden on the health system.

METHODS: We conducted a systematic review of the existing economic literature on systematic screening for TB to summarise costs, cost-effectiveness and affordability, and the key factors that influence costs and cost-effectiveness. Specific populations of interest included the general population, children and close contacts of TB patients.

RESULTS: We identified 21 studies that provided both cost and outcome data on TB screening among the populations of interest. All were from low- and middle-income settings. Studies were heterogenous in the intervention, and included costs and reported outcomes. The incremental cost-effectiveness ratio (ICER) estimates ranged from USD281 to USD698 per disability-adjusted life-year (DALY) averted among the general population, USD619/DALY averted among children and USD372–3,718/DALY averted among close contacts.

CONCLUSION: Prevalence of TB among targeted high-risk groups was identified across the majority of studies as a driver of cost-effectiveness. The heterogeneity of the included costs and outcomes across the economic literature for systematic screening suggests a need for standardisation of included cost components and key economic evaluation methods to improve comparability and generalisability of results.

Keywords: health economics; modelling; prevention/control programme; tuberculosis

Document Type: Research Article

Affiliations: 1: School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada, Children´s Hospital of Eastern Ontario, Ottawa, ON, Canada 2: School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada 3: Global TB Programme, World Health Organization, Geneva, Switzerland

Publication date: January 1, 2022

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