Cost-Effectiveness of Follow-Up of Chronic Coughers in Detecting Smear-Positive Tuberculosis in South Ethiopia

INTRODUCTION: In Ethiopia, no studies assessing the cost-effectiveness of follow-up of smear-negative chronic coughers in detecting smear-positive tuberculosis (TB) (PTB+) cases have been reported. OBJECTIVE: This article describes the cost-effectiveness of community-based follow-up of smear-negative chronic coughers in detecting PTB+ cases. METHODS: Two alternative strategies of TB case finding, namely community-based follow-up of smear-negative chronic coughers and passive TB case finding, were compared. Participants were selected randomly in the active TB case finding approach, while purposively in the passive TB case finding strategy. In November 2012 and January 2015, costs related to TB diagnosis were collected using structured questionnaires from sample of 60 patients in each strategy. Data on health system cost and direct and indirect costs incurred by patients and their caretakers were collected in Ethiopian Birr and converted into USD for analysis. Exchange rate for the data collection period of chronic coughers was 1 USD = 18.16 ETB and for passive case finding period was 1 USD = 20.24 ETB. Cost-effectiveness was calculated in terms of cost per PTB+ cases detected. RESULTS: The overall cost of TB case finding was lower under active case finding approach than under passive TB case finding approach (USD 27.4 vs. 27.6). Active case finding approach was cost-effective by 43.4% and it is highly cost-effective when the duration of follow-up is reduced to 7 months or less. CONCLUSION: Active case finding approach is a cost-effective approach of TB case finding. The cost benefit obtained could be even higher when the follow-up duration is minimized.