Cost-effective analysis of active case finding (ACF) strategy to detect pulmonary tuberculosis (PTB) in selected public health care facilities of the northern state, India

Abstract

Background

In addition to passive case finding (PCF), active case finding (ACF) strategy under National Tuberculosis Elimination Program is a vital secondary prevention intervention under National Strategic Plan (NSP). The present study was conducted to assess ACF's cost-effectiveness compared to PCF in selected public health facilities for the detection of presumptive TB cases under NTEP.

Material and methods

A cross-sectional study was carried out in randomly selected seven public health facilities of a health block of one district of Himachal Pradesh. Bottom-up costing method was used with bootstrapping of results to assess incremental cost-effectiveness ratio (CEAC) and cost-effectiveness acceptability curve (CEAC).

Results

Mean cost for ACF and PCF with US$ 3325.8 and 3006.0 respectively to detect all presumptive PTB cases; and US$ 4121.2 and to US$ 3709.0 to confirm all PTB cases. Below WTP threshold (per capita income US$ 2735), WTP 80.3% of simulated ICER values were cost-effective. CEAC showed that saturation was achieved around US$ 300 indicating a likely WTP threshold at which 79.5% of simulated values were cost-effective. For both strategies, One way sensitivity analysis showed the cost is influenced mostly by human resources.

Conclusion

Current study used bottom-up costing method in public health care facilities observed ACF as a cost-effective strategy in reaching out for presumptive PTB. The major cost driver in both strategies is human resource for training, travelling, and administration.