Table 1. Analytic and reporting framework for total, activity-specific, and program yield costs of active-case finding programs.
| Cambodia (CATA) | Pre-implementation | Screening | Diagnosis | Treatment | ||||
| Resource categories | Total cost (%) | Community Sensitization | Ad-hoc staff training | Staff training | Community based | CXR | Xpert | Treatment |
| Human resources | $57,728 (17%) | $32,277 | $3,791 | $477 | $18,212 | $1,485 | $1,485 | NA |
| Capital cost | $71,964 (21%) | $2,003 | $5,787 | $1,016 | $119 | $34,468 | $28,571 | NA |
| Recurrent costs | $183,018 (54%) | $0 | $0 | $0 | $53,232 | $43,136 | $86,650 | NA |
| Overhead costs | $24,241 (7%) | $13,554 | $1,592 | $200 | $7,647 | $624 | $624 | NA |
| Total activity costs | $336,951 | $47,834 | $11,171 | $1,693 | $79,210 | $79,712 | $117,330 | NA |
| Incremental costs for yield | $139,9083 | $204,1984 | $272,6605 | NA | ||||
| Types of services | Number of beneficiaries | Cost per activity1 | ||||||
| Population enrollment | 125,842 | $0.38 | $0.09 | $0.01 | $0.63 | |||
| CXR test | 23,797 | $3.35 | ||||||
| Xpert test | 4,604 | $25.48 | ||||||
| Treatment referred | 4,604 | NA | ||||||
| Program yield indicators | Number of yield | Cost per yield2 | ||||||
| Presumptive TB cases identified | 28,038 | $4.99 | ||||||
| TB cases diagnosed by all form TB (including CXR or routine clinical evaluation) | 1,427 | $143.106 |
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| TB cases diagnosed by Xpert | 731 | $373 | ||||||
| Treatment completed | NA | NA | ||||||
| Tajikistan (NTP) | Pre-implementation | Screening | Diagnosis | Treatment | ||||
| Resource categories | Total cost (%) | Community Sensitization | Ad-hoc staff training | Staff training | Facility based | CXR | X-pert | Treatment |
| Human resources | $157,509 (20%) | $43,253 | $2,591 | $14,859 | $93,866 | NA | $2,941 | NA |
| Capital cost | $190,614 (25%) | $12,525 | $4,453 | $17,674 | $93,336 | NA | $62,625 | NA |
| Recurrent costs | $258,792 (34%) | $0 | $0 | $0 | $3,310 | NA | $255,482 | NA |
| Overhead costs | $164,513 (21%) | $42,042 | $40,214 | $42,042 | $10,968 | NA | $29,247 | NA |
| Total activity costs | $771,429 | $97,820 | $47,258 | $74,576 | $201,480 | NA | $350,295 | NA |
| Incremental costs for yield | $421,134 | NA | $771,4297 | NA | ||||
| Types of services | Number of beneficiaries | Cost per activity | ||||||
| Population enrollment | 1,980,516 | $0.05 | $0.02 | $0.04 | $0.10 | |||
| CXR test | NA | NA | ||||||
| Xpert test | 19,764 | $17.72 | ||||||
| Treatment referred | 19,764 | NA | ||||||
| Program yield indicators | Number of yield | Cost per yield | ||||||
| Presumptive TB cases identified | 22,086 | $19.07 | ||||||
| TB cases diagnosed by all form TB8 | 3,979 | NA8 | ||||||
| TB cases diagnosed by Xpert | 2,246 | $343.47 | ||||||
| Treatment completed | NA | NA | ||||||
1. Cost per activity is calculated by respective activity costs divided by a number of relevant beneficiaries served.
2. Cost per yield is then calculated by respective incremental screening/diagnostic test costs divided by numbers of relevant service outputs such as presumptive TB cases determined by screening and TB cases diagnosed by Xpert/CXR.
3. The total Xpert cost also include costs incurred by the routine clinic service (i.e. clinical evaluation + smear performed) before Xper test.$139,908 = $47,834 + $11,171 + $1,693 + $79,210; we incrementally added the relevant activity costs–upto screening—for presumptive TB identified as those (27,554) are the result of the pre-implementation and screening activities.
4. $204,198 = $47,834 + $11,171 + $1,693 + $79,210 + $79,712 - (4,604*$3.35); we incrementally added the relevant activity costs–upto CXR—for TB cases diagnosed by CXR (1,425) but deducted (4,604*$3.35) from the total CXR activity costs ($79,712) because 4,604 people further required Xpert test to determine TB except extrapulmonary tuberculosis.
5. $272,660 = $47,834 + $11,171 + $1,693 + $79,210 + (4,604*$3.35) + $117,330; we incrementally added the relevant activity costs–upto X-pert except CXR–for TB cases diagnosed by X pert (728). We only added (4,604*$3.35) out of $79,712 from CXR cost in order to account only attributed CXR costs for those (4,604 out of 23,797) who also received X-pert tests after abnormal CXR.
6. This cost per yield ($143.10 in Cambodia) is related to referred patients by the CATA program for all non X-pert testing patients to the routine clinic as it operated at the health center. Considering the full diagnostic algorithms including routine clinic evaluation and bacteriologic testing, the costs per yield may be greater than our current estimates, we did not include these costs as they were outside the scope of the ACF operations.
7. In Tajikistan, we incrementally added activity costs for TB cases diagnosed by Xpert. Likely, the incremental costs for yield may vary depending on the diagnostic algorithms. To calculate an accurate cost per TB cases detected, it is therefore important to carefully account attributed costs to the particular yield–not simply using a total program or activity costs—based on patients' flows.
8. This figure includes TB patients independently identified by the National TB Program; thus, we denoted “NA” for the cost per program yield cell of the reporting table as we are not able to further declassify relevant resource used for those TB patients identified outside and costs for those yield estimates that are not solely or activity category cells which were not included into our costing analyses.