Table 3:
Clinical and economic outcomes, including cost-effectiveness, of tuberculosis screening strategies among hospitalised people with HIV
| Mortality |
Lifetime outcomes |
||||||
|---|---|---|---|---|---|---|---|
| 2 months | 2 years | 5 years | Life-years (undiscounted) | Life-years (discounted)* | Cost (US$; discounted)*† | ICER (US$/YLS; discounted)†‡ | |
| Intervention in all patients (sputum Xpert, urine TB-LAM, and concentrated urine Xpert) | |||||||
| Malawi | |||||||
| Standard of care | 24·4% | 40·7% | 50·5% | 12·5 | 8·4 | 3450 | ·· |
| Intervention | 20·9% | 35·2% | 45·8% | 13·7 | 9·1 | 3790 | 450 |
| South Africa | |||||||
| Standard of care | 17·7% | 32·0% | 42·4% | 14·1 | 9·5 | 8500 | ·· |
| Intervention | 15·5% | 29·6% | 40·4% | 14·6 | 9·8 | 8770 | 840 |
| Intervention in patients with CD4 counts <100 cells per μL (sputum Xpert, urine TB-LAM, and concentrated urine Xpert) | |||||||
| Malawi | |||||||
| Standard of care | 40·5% | 65·2% | 75·6% | 6·3 | 4·3 | 2090 | ·· |
| Intervention | 33·7% | 58·5% | 70·6% | 7·6 | 5·2 | 2500 | 490 |
| South Africa | |||||||
| Standard of care | 32·2% | 55·9% | 67·8% | 8·2 | 5·6 | 6920 | ·· |
| Intervention | 23·9% | 50·2% | 63·7% | 9·2 | 6·3 | 7630 | 1000 |
| Modified intervention in all patients (sputum Xpert and urine TB-LAM) | |||||||
| Malawi | |||||||
| Standard of care | 24·4% | 40·7% | 50·5% | 12·5 | 8·4 | 3450 | ·· |
| Modified intervention | 21·1% | 35·5% | 46·0% | 13·6 | 9·1 | 3750 | 420 |
| South Africa | |||||||
| Standard of care | 17·7% | 32·0% | 42·4% | 14·1 | 9·5 | 8500 | ·· |
| Modified intervention | 16·0% | 30·2% | 41·0% | 14·5 | 9·7 | 8690 | 810 |
| Intervention vs modified intervention in all patients | |||||||
| Malawi | |||||||
| Modified intervention | 21·1% | 35·5% | 46·0% | 13·6 | 9·1 | 3750 | ·· |
| Intervention | 20·9% | 35·2% | 45·8% | 13·7 | 9·1 | 3790 | 910 |
| South Africa | |||||||
| Modified intervention | 16·0% | 30·2% | 41·0% | 14·5 | 9·7 | 8690 | ·· |
| Intervention | 15·5% | 29·6% | 40·4% | 14·6 | 9·8 | 8770 | 930 |
Values are calculated in 2017 US$. ICER=incremental cost-effectiveness ratio. YLS=year of life saved. Xpert=GeneXpert assay for Mycobacterium tuberculosis and rifampicin resistance. TB-LAM=lateral flow urine assay for M tuberculosis lipoarabinomannan.
Discounted 3% per year.
Cost includes all health-care expenditures.
The ICER is the difference between the intervention and standard of care or between the modified intervention and standard of care in discounted costs divided by the difference in discounted life-years. The displayed life-years and costs are rounded, but the ICER was calculated with non-rounded life-years and costs. We considered the intervention or the modified intervention to be cost-effective if its ICER was less than the cost-effectiveness thresholds of $750/YLS in Malawi and $940/YLS in South Africa (the ICERs of including second-line antiretroviral therapy in these countries).