TABLE 3. Costs and outcomes in economic evaluations on interventions designed to tackle tuberculosis (TB) in homeless people.
Study | Intervention | Cost | Outcome |
---|---|---|---|
Jit et al. (19)a | Diagnosis 1. Having no Find and Treat service 2. Having only one part of the service (the mobile screening unit or the case management component) 3. Having both parts of the Find and Treat service |
Direct health care costs: salaries; training and development; travel and subsistence; administration; maintenance; cleaning; insurance; fuel; office management; radiography equipment maintenance; tests; overhead; and TB treatment; including multidrug-resistant patients Total cost: with Find and Treat (US$ 2.21 million); without Find and Treat (US$ 400 000) |
QALYb: patients with no treatment (0.68); after two months of treatment (0.81) Loss to follow-up: Find and Treat service (2.1%); no Find and Treat service (17.2%) Completed treatment: Find and Treat service (67.1%); no Find and Treat service (56.8%) |
Linas et al. (20) | Diagnosis (screening) 1. No screening 2. Using TSTc to screen 3. Using IGRAd to screen |
Direct health care costs: TST and IGRA screening; diagnostic; physician and nurse visits; drugs; hospitalization; DOTe; contact tracing Compared with TST screening, IGRA resulted in incremental costs ranging from a savings of US$ 10 to a cost of US$ 20. |
Sensitivity: TST (89%); IGRA (83%) Specificity: TST (92%–98%); IGRA (99%) Number needed to screen to prevent one case of active TB: TST (436); IGRA (411) Life expectancy: compared with TST screening, IGRA resulted in undiscounted life expectancy gains of 0.00–0.01 life months. QALY: cured (1.0); nonfatal isoniazid hepatitis (0.85); active TB (0.8) |
Nettleman (21) | Prevention 1. No vaccination 2. BCGf vaccination |
Direct health care costs: vaccine and side effects; diagnostic tests; hospitalizations; outpatient visits; drug therapy, including TB-resistant; cost of testing and treating close contacts Cost per case of active TB: US$ 7 526 |
Efficacy of BCG vaccination in preventing TB: 8%–100% At an efficacy of 50%, approximately one life would be saved, 12 life years would be gained, and 23 cases of active TB would be prevented for every 1 000 persons entering the vaccination program. |
Tulsky et al. (22) | Treatment (incentive for adhering to treatment) 1. Cash incentive (US$ 5 payment); noncash incentive (fast food or grocery coupons, phone cards, or bus tokens, with a face value of US$ 5) |
Direct health care costs: incentives (US$ 5), staff time, cost of rent, office supplies, phone lines, and personalized letter Total cost of incentive-enhanced DOPTg was US$ 460.98 per participant in the cash incentive group and US$ 494.45 in the noncash incentive group. |
Completion of preventive therapy: cash incentive group (89%); noncash incentive group (81%), with P = 0.23 Median and mean follow-up hours were 0.5 and 2.0 in the cash incentive group compared to 1.7 and 4.5 in the noncash incentive group. |
LoBue et al. (23) | Treatment (housing program) 1. Housing for homeless people 2. Hospitalization |
Direct health care costs: health staff, treatment, drug, DOT, hospitalization Cost per day: housing program (US$ 55.90); hospital (US$ 651) Projected total cost saving of housing program: US$ 27 034.54 per patient |
Completion of therapy: 84.6% to 100% |
Source: Compiled by the authors based on the results of the systematic review.
British pounds were converted to US$ using an exchange rate of £ 1 = US$ 1.30.
QALY: quality-adjusted life years.
TST: [Mantoux] tuberculin skin test.
IGRA: interferon-gamma release assay.
DOT: Directly Observed Therapy.
BCG: Bacillus Calmette–Guérin vaccine.
DOPT: Directly Observed Prevention Therapy.