Figure 1.

Efficiency frontiers for different community-based screening approaches for tuberculosis. Panels A to E show total costs in 2023 (USD, y-axis, in millions) of each screening strategy plotted against the number of DALYs averted (x-axis, in thousands), per 100 000 people screened. The black triangle corresponds to case-finding Scenario 1 (no case-finding, with further details in the methods), the red square to Scenario 2 (CRP testing), and the yellow circle to Scenario 4 (Xpert for all). The different scenarios (3a–c) are denoted by the blue and purple squares: the single blue square (top) corresponds to Scenario 3a, the upper of the 2 purple squares to Scenario 3b, and the lower purple square to Scenario 3c. The slope of the solid line represents the ICER of scenarios 1, 2, and 3a; that is, the cost per DALY averted upon shifting from 1 strategy to the next most effective strategy along the efficiency frontier. Strategies not on the frontier are less cost-effective than combinations of strategies that appear on the frontier, and only the ICERs between those strategies appearing on the frontier are shown. For example, in India (panel A), the CRP (Scenario 2, yellow), the Hypothetical Screening test (Scenario 3a, blue), and the Xpert for all (Scenario 1, yellow) strategy are on the efficiency frontier, and respective ICERs are noted next to each strategy. In the other countries, the baseline Hypothetical Screening test is always less cost-effective than Xpert for all, and only the ICER comparing Xpert for all to CRP is shown. The ICER resulting from an improved Hypothetical Screening test (Scenario 3c, lower purple square) is shown by the dotted black line. Supplementary Figure 5 presents an alternative analysis for South Africa, reflecting alternative, lower cost estimates in that setting. Abbreviations: CRP, C-reactive protein; DALY, disability adjusted life year; ICER, incremental cost-effectiveness ratio, USD, United States dollars.