AN ECONOMIC EVALUATION, ALONGSIDE A RANDOMIZED CONTROLLED TRIAL, TO ASSESS THE EFFECTIVENESS OF A CASE-FINDING STRATEGY FOR TUBERCULOSIS IN SOWETO, SOUTH AFRICA

Embargo until
2024-08-01
Date
2023-06-01
Journal Title
Journal ISSN
Volume Title
Publisher
Johns Hopkins University
Abstract
Problem statement: Novel methods of improving the identification of patients with undiagnosed TB are required. A possible approach, assessed in the ACTTIS trial in South Africa, is to identify and link to treatment household contacts of paediatric patients with confirmed TB. However, the cost-effectiveness of this approach, the costs of scaling it up, and its impact on TB transmission overall, are not known. Methods: We used a cost-effectiveness model to compare the costs and effectiveness values of the intervention (ACTTIS arm) and the control (SOC+), using measured costs in ZAR and DALY values as a measure of effectiveness. The incremental cost-effectiveness ratio (ICER) values and various sensitivity analyses were computed. We calculated the total cost of scaling the intervention (and SOC+ control) to all paediatric index patients in South Africa and their household contacts, as well as costs averted through reduced hospitalization. We used a Susceptible Exposed Infected Recovered (SEIR) model to simulate the impact of introducing the intervention in a hypothetical South African population. Results: The overall ICER of the ACTTIS intervention relative to the SOC+ arm was computed as -ZAR 4,954 per additional DALY averted (95% CI: -5,148; -4,760). This is highly cost-effective. One-way and probabilistic sensitivity analyses showed robustness to various input parameters. The total budget impact of scaling up ACTTIS or SOC+ to all undiagnosed paediatric patients and their immediate household contacts was estimated to be ZAR 1.219 billion for ACTTIS and ZAR 644 million for SOC+, accounting for hospitalization costs. Our simulation model showed that over a 10-year period, implementation of ACTTIS in a hypothetical cohort of 100,000 South African patients resulted in a reduction of total infections by 45% (from 6,807 to 3,611) and averted 929 deaths (95% CI: 889, 973), with an ICER of ZAR 5,760.62 per death averted (95% CI: 5,500.96;6,021.11). The net benefits of the intervention approximate ZAR 1.3 billion per 100,000 population (ZAR 1.2-1.37 billion) at a return of investment of ZAR1.96 per ZAR 1 invested in the ACTTIS program (1.86-2.08). Conclusions: The case-finding strategy deployed in the ACTTIS trial is highly cost-effective, potentially reducing the transmission of TB.
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Keywords
cost-effectiveness, TB
Citation