Table 2.
Clinical impact, costs, and incremental cost-effectiveness of TB screening strategies among individuals initiating ART in South Africa.
| Strategy | TB-infected LE (months) | Population LE (months) | Lifetime Cost (2010 USD) | ICER ($/YLS) | ||
|---|---|---|---|---|---|---|
| undiscounted | discounted | undiscounted | discounted | |||
| No Screening | 116.2 | 90.6 | 151.7 | 117.0 | 31,240 | -- |
|
| ||||||
| Smear-2-Symptoms* | 118.4 | 92.3 | 152.2 | 117.4 | 31,320 | 2,600 |
|
| ||||||
| Smear-2-All | 118.8 | 92.6 | 152.3 | 117.5 | 31,340 | 2,800 |
|
| ||||||
| Culture-2-Symptoms | 121.4 | 94.5 | 152.9 | 117.9 | 31,520 | dominated† |
|
| ||||||
| Culture-2-All | 122.4 | 95.3 | 153.1 | 118.1 | 31,580 | 5,100‡ |
|
| ||||||
| Xpert-1-Symptoms | 122.3 | 95.2 | 153.1 | 118.0 | 31,610 | dominated† |
|
| ||||||
| Xpert-1-All | 123.4 | 96.0 | 153.3 | 118.2 | 31,670 | dominated† |
|
| ||||||
| Xpert-2-Symptoms | 123.7 | 96.2 | 153.4 | 118.3 | 31,690 | dominated† |
|
| ||||||
| Xpert-2-All | 125.1 | 97.3 | 153.7 | 118.5 | 31,770 | 5,100‡ |
Costs in 2010 U.S. dollars and are discounted. LE: life expectancy. ICER: incremental cost-effectiveness ratio. YLS: year of life saved. Culture strategies included smear microscopy and drug susceptibility testing on cultures.
Numbers in the table have been rounded; small deviations in individual calculations may be due to rounding.
Format of strategies is test-number-population, such that Smear-2-Symptoms refers to two smears in symptomatic individuals, etc.
‘dominated’: strategies with lower life expectancy and higher cost, or a higher ICER than a more effective strategy.
ICER for Culture-2-All ($5,060/YLS) is less than ICER for Xpert-2-All ($5,140/YLS), but appears same due to rounding.