Table 2. Strengths and weaknesses of studies included in a systematic review of cost-effectiveness of active tuberculosis screenings among high-risk populations in low tuberculosis incidence countries, 1 January 2008–31 December 2023 (n = 9).
| Study | Strengths | Weaknesses |
|---|---|---|
| Pareek et al. [15] | Identification of optimal screening thresholds | Empirical data were available from a small sample size |
| Final recommendations supported by real data | Assumptive rates of HIV, chemoprophylaxis acceptance and completion | |
| Suggested threshold incidence for screening | Model considered one generation of TB transmission | |
| Limited concurrent screening | ||
| Cavany et al. [16] | Proposed novel way to quantify effectiveness of contact tracing | Uncertain rate of transmission |
| High-quality real data used | No analysis of the indirect impact of contact tracing on transmission within the population | |
| The infectious period of index patients was estimated based on self-reported symptomatic periods | ||
| Capocci et al. [17] | First reported study to model different testing strategies for LTBI, asymptomatic and symptomatic TB disease in PLHIV | Only 50% of approached patients agreed to participate |
| Real data used | Difficulties in determining TB cases accurately in individuals with TST/IGRA undergoing ART was challenging | |
| Suggested threshold incidence for screening | ||
| Jit et al. [18] | Not to overestimate benefit of the screening, analysis was performed using both favourable and unfavourable assumptions. | Lack or randomisation of managed and non-managed individuals, resulting in uncertainty of the outcomes |
| Real data used | Secondary transmission was not considered in economic evaluation | |
| Likelihood of patients developing and transmitting drug resistance was not measured | ||
| Verma et al. [19] | Identified the risk of LTBI reactivation as the most influential variable in the analysis | Limited data on LTBI reactivation risk |
| Lack of considering death before transmission, movement into and out of long-term care, environmental factors | ||
| Uppal et al. [20] | Highlighted the importance of involving communities in screening activities | Assumptive costs of LTBI and active TB case detection |
| Emphasised on benefits of early case detection | Lack of age stratification, region-specific data for certain parameters | |
| Real data used | ||
| Smit et al. [21] | Real data used | Contact investigation considered as an independent component |
| Possible applicability of the results to other low-incidence countries | ||
| Wahedi et al. [22] | Real data used | Uncertain rate of transmission |
| Stratification of individuals | No data on MDR-TB prevalence | |
| Suggested threshold incidence for screening | The cost of overdiagnosis was assessed regarding CXR, with no examination of cost of confirmatory diagnosis or treatment initiation. | |
| Goscé et al. [23] | Real data used | Did not use transmission dynamic model |
| Using a “do-nothing” approach as a comparator was challenging because of incurred costs from late case detection | ||
| Individuals were not followed up to assess effects of early detection or the consequences of failing to identify cases. |
ART: antiretroviral therapy; CXR: chest X-ray; HIV: human immunodeficiency virus; IGRA: interferon-gamma release assay; LTBI: latent tuberculosis infection; MDR-TB: multidrug-resistant tuberculosis; PLHIV: people living with human immunodeficiency virus; TB: tuberculosis; TST: tuberculin skin test.