Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial
Summary: Background: Active case finding is recommended as an important strategy to control tuberculosis, particularly in low-income and middle-income countries with a high prevalence of the disease. However, the costs and cost-effectiveness of active case finding are unclear due to the absence of...
Main Authors: | , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2019-03-01
|
Series: | The Lancet Global Health |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X18305205 |
id |
doaj-19782f263e32408cbb1e105bdf23dc4e |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Thomas Lung, PhD Guy B Marks, PhD Nguyen Viet Nhung, PhD Nguyen Thu Anh, PhD Nghiem Le Phuong Hoa, MSc Le Thi Ngoc Anh, BSc Nguyen Binh Hoa, PhD Warwick John Britton, PhD Jessica Bestrashniy, PhD Stephen Jan, PhD Gregory J Fox, PhD |
spellingShingle |
Thomas Lung, PhD Guy B Marks, PhD Nguyen Viet Nhung, PhD Nguyen Thu Anh, PhD Nghiem Le Phuong Hoa, MSc Le Thi Ngoc Anh, BSc Nguyen Binh Hoa, PhD Warwick John Britton, PhD Jessica Bestrashniy, PhD Stephen Jan, PhD Gregory J Fox, PhD Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial The Lancet Global Health |
author_facet |
Thomas Lung, PhD Guy B Marks, PhD Nguyen Viet Nhung, PhD Nguyen Thu Anh, PhD Nghiem Le Phuong Hoa, MSc Le Thi Ngoc Anh, BSc Nguyen Binh Hoa, PhD Warwick John Britton, PhD Jessica Bestrashniy, PhD Stephen Jan, PhD Gregory J Fox, PhD |
author_sort |
Thomas Lung, PhD |
title |
Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial |
title_short |
Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial |
title_full |
Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial |
title_fullStr |
Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial |
title_full_unstemmed |
Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trial |
title_sort |
household contact investigation for the detection of tuberculosis in vietnam: economic evaluation of a cluster-randomised trial |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2019-03-01 |
description |
Summary: Background: Active case finding is recommended as an important strategy to control tuberculosis, particularly in low-income and middle-income countries with a high prevalence of the disease. However, the costs and cost-effectiveness of active case finding are unclear due to the absence of evidence from randomised trials. We assessed the costs and cost-effectiveness of an active case finding strategy in Vietnam, where there is a high prevalence of tuberculosis. Methods: We conducted an economic evaluation alongside the Active Case Finding in Tuberculosis (ACT2) trial—a pragmatic cluster-randomised controlled trial in 70 districts across eight provinces of Vietnam. Patients aged 15 years and older with smear-positive pulmonary tuberculosis were recruited to the trial if they lived with one or more other household members. Household contacts were verbally invited to the clinic by the index patient with tuberculosis. ACT2 compared a combination of active and passive case finding with usual care (passive case finding) of household contacts of patients with tuberculosis from a health system perspective. Clustering occurred at the district and household level. Districts were the unit of randomisation, and we used minimisation to ensure balance of intervention and control districts within each province. In the intervention group, participants were invited to attend screening at baseline, 6 months, 12 months, and 24 months. We determined health-care costs with a standardised national costing survey and reported results in 2017 $US. The primary outcome of our study was disability-adjusted life years (DALYs) averted over a 24-month period. ACT2 was registered prospectively with the Australian and New Zealand Clinical Trials Registry, number ACTRN126.100.00600044. Findings: Between Aug 11, 2010, and Aug 11, 2015, 10 964 index patients and 25 707 household contacts completed the ACT2 study. There were 10 069 household contacts in the intervention group and 15 638 household contacts in the control group. The incremental cost-effectiveness ratio per DALY averted was $544 (330–1375). Interpretation: Active case finding was shown to be highly cost-effective in a setting with a high prevalence of tuberculosis. Investment in the wide-scale implementation of this programme in Vietnam should be strongly supported. Funding: Australian National Health and Medical Research Council. |
url |
http://www.sciencedirect.com/science/article/pii/S2214109X18305205 |
work_keys_str_mv |
AT thomaslungphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT guybmarksphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT nguyenvietnhungphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT nguyenthuanhphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT nghiemlephuonghoamsc householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT lethingocanhbsc householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT nguyenbinhhoaphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT warwickjohnbrittonphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT jessicabestrashniyphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT stephenjanphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial AT gregoryjfoxphd householdcontactinvestigationforthedetectionoftuberculosisinvietnameconomicevaluationofaclusterrandomisedtrial |
_version_ |
1725020508167077888 |
spelling |
doaj-19782f263e32408cbb1e105bdf23dc4e2020-11-25T01:46:10ZengElsevierThe Lancet Global Health2214-109X2019-03-0173e376e384Household contact investigation for the detection of tuberculosis in Vietnam: economic evaluation of a cluster-randomised trialThomas Lung, PhD0Guy B Marks, PhD1Nguyen Viet Nhung, PhD2Nguyen Thu Anh, PhD3Nghiem Le Phuong Hoa, MSc4Le Thi Ngoc Anh, BSc5Nguyen Binh Hoa, PhD6Warwick John Britton, PhD7Jessica Bestrashniy, PhD8Stephen Jan, PhD9Gregory J Fox, PhD10The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia; Correspondence to: Dr Thomas Lung, The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, AustraliaSouth Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia; Woolcock Institute of Medical Research, Glebe, NSW, AustraliaNational Lung Hospital, Ba Dinh, Hanoi, Vietnam; Hanoi Medical University, Hanoi, VietnamWoolcock Institute of Medical Research, Glebe, NSW, AustraliaWoolcock Institute of Medical Research, Glebe, NSW, AustraliaWoolcock Institute of Medical Research, Glebe, NSW, AustraliaNational Lung Hospital, Ba Dinh, Hanoi, Vietnam; Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, FranceFaculty of Medicine and Health, University of Sydney, NSW, Australia; Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Camperdown, NSW, AustraliaWoolcock Institute of Medical Research, Glebe, NSW, AustraliaThe George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, AustraliaFaculty of Medicine and Health, University of Sydney, NSW, Australia; Woolcock Institute of Medical Research, Glebe, NSW, AustraliaSummary: Background: Active case finding is recommended as an important strategy to control tuberculosis, particularly in low-income and middle-income countries with a high prevalence of the disease. However, the costs and cost-effectiveness of active case finding are unclear due to the absence of evidence from randomised trials. We assessed the costs and cost-effectiveness of an active case finding strategy in Vietnam, where there is a high prevalence of tuberculosis. Methods: We conducted an economic evaluation alongside the Active Case Finding in Tuberculosis (ACT2) trial—a pragmatic cluster-randomised controlled trial in 70 districts across eight provinces of Vietnam. Patients aged 15 years and older with smear-positive pulmonary tuberculosis were recruited to the trial if they lived with one or more other household members. Household contacts were verbally invited to the clinic by the index patient with tuberculosis. ACT2 compared a combination of active and passive case finding with usual care (passive case finding) of household contacts of patients with tuberculosis from a health system perspective. Clustering occurred at the district and household level. Districts were the unit of randomisation, and we used minimisation to ensure balance of intervention and control districts within each province. In the intervention group, participants were invited to attend screening at baseline, 6 months, 12 months, and 24 months. We determined health-care costs with a standardised national costing survey and reported results in 2017 $US. The primary outcome of our study was disability-adjusted life years (DALYs) averted over a 24-month period. ACT2 was registered prospectively with the Australian and New Zealand Clinical Trials Registry, number ACTRN126.100.00600044. Findings: Between Aug 11, 2010, and Aug 11, 2015, 10 964 index patients and 25 707 household contacts completed the ACT2 study. There were 10 069 household contacts in the intervention group and 15 638 household contacts in the control group. The incremental cost-effectiveness ratio per DALY averted was $544 (330–1375). Interpretation: Active case finding was shown to be highly cost-effective in a setting with a high prevalence of tuberculosis. Investment in the wide-scale implementation of this programme in Vietnam should be strongly supported. Funding: Australian National Health and Medical Research Council.http://www.sciencedirect.com/science/article/pii/S2214109X18305205 |