Cost-Effectiveness of adding Tuberculosis Active Case Finding on Passive Case Screening Approach in Dire Dawa Town
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Date
2018-11
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Addis Ababa Universty
Abstract
Introduction: The standard passive case finding (PCF) strategy is inadequate in detecting all
TB cases. Active case finding (ACF) was suggested to be effective alternative, but empirical
evidence of its cost-effectiveness is sparse. Prevention and control of tuberculosis (TB) is one
of the components in the health extension package (HEP)and follow-up of contact tracing in
tuberculosis (TB) burden areas, such as Dire Dawa is beneficial in improving smear-positive
tuberculosis (TB)case detection the presence of those Health Extension workers in each
community. This study evaluated the cost effectiveness of community active case finding
compared to passive case finding in Dire Dawa town.
Objective: The objective of this study is to compare cost effectiveness of active and passive
case finding for tuberculosis in Dire Dawa Town.
Methods: A Cross sectional study design was used and the economic cost was performed
from provider perspective. The costing was based on bottom up costing method and
intermediate outcome of number of TB case found by each interventions was used as an
effectiveness. Decision tree model was structured and constructed to compare the cost
effectiveness of Active case finding with a passive case finding and Incremental cost
effectiveness ratio(ICER) of the least cost effective strategy was reported. One-way sensitivity
analysis using tornado diagram was performed on costs and probabilities.
Results: The cost effectiveness study showed that incremental cost effectiveness ratio (ICER)
of active case finding compared with passive one was found to be $536.6 per positive TB case.
Based on the Gross Domestic Product (GDP) rule as per the recommendation of World Health
Organization (WHO) which was used to recommend cost effectiveness intervention showed
that the 2017 GDP per capita estimate of Ethiopia to be $873, and in this case active case
finding is the cost-effective intervention.
Conclusion: Active case finding is optimal intervention to identify more number of positive
TB case finding with less cost than the passive case finding. Therefore, I strongly suggest the
use of ACF to improve the health of the community and to reduce economic burden incurred
due to tuberculosis.
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Keywords
cost effectiveness analysis, active case finding, passive case finding