Garg Tushar, John Stephen, Abdulkarim Suraj, Ahmed Adamu D, Kirubi Beatrice, Rahman Md Toufiq, Ubochioma Emperor, Creswell Jacob
Stop TB Partnership, Geneva, Switzerland.
Janna Health Foundation, Yola, Adamawa State, Nigeria.
PLOS Digit Health. 2025 Jun 11;4(6):e0000894. doi: 10.1371/journal.pdig.0000894. eCollection 2025 Jun.
Availability of ultraportable chest x-ray (CXR) and advancements in artificial intelligence (AI)-enabled CXR interpretation are promising developments in tuberculosis (TB) active case finding (ACF) but costing and cost-effectiveness analyses are limited. We provide implementation cost and cost-effectiveness estimates of different screening algorithms using symptoms, CXR and AI in Nigeria. People 15 years and older were screened for TB symptoms and offered a CXR with AI-enabled interpretation using qXR v3 (Qure.ai) at lung health camps. Sputum samples were tested on Xpert MTB/RIF for individuals reporting symptoms or with qXR abnormality scores ≥0.30. We conducted a retrospective costing using a combination of top-down and bottom-up approaches while utilizing itemized expense data from a health system perspective. We estimated costs in five screening scenarios: abnormality score ≥0.30 and ≥0.50; cough ≥ 2 weeks; any symptom; abnormality score ≥0.30 or any symptom. We calculated total implementation costs, cost per bacteriologically-confirmed case detected, and assessed cost-effectiveness using incremental cost-effectiveness ratio (ICER) as additional cost per additional case. Overall, 3205 people with presumptive TB were identified, 1021 were tested, and 85 people with bacteriologically-confirmed TB were detected. Abnormality ≥ 0.30 or any symptom (US$65704) had the highest costs while cough ≥ 2 weeks was the lowest (US$40740). The cost per case was US$1198 for cough ≥ 2 weeks, and lowest for any symptom (US$635). Compared to baseline strategy of cough ≥ 2 weeks, the ICER for any symptom was US$191 per additional case detected and US$ 2096 for Abnormality ≥0.30 OR any symptom algorithm. Using CXR and AI had lower cost per case detected than any symptom screening criteria when asymptomatic TB was higher than 30% of all bacteriologically-confirmed TB detected. Compared to traditional symptom screening, using CXR and AI in combination with symptoms detects more cases at lower cost per case detected and is cost-effective. TB programs should explore adoption of CXR and AI for screening in ACF.
超便携式胸部X光（CXR）的可用性以及人工智能（AI）辅助的CXR解读技术的进步，在结核病（TB）活动性病例发现（ACF）方面是很有前景的进展，但成本及成本效益分析有限。我们提供了在尼日利亚使用症状、CXR和AI的不同筛查算法的实施成本及成本效益估计。对15岁及以上人群进行结核病症状筛查，并在肺部健康营中为其提供采用qXR v3（Qure.ai）进行AI解读的CXR检查。对报告有症状或qXR异常评分≥0.30的个体，其痰液样本采用Xpert MTB/RIF进行检测。我们采用自上而下和自下而上相结合的方法进行回顾性成本核算，同时从卫生系统角度利用分项费用数据。我们估计了五种筛查方案的成本：异常评分≥0.30和≥0.50；咳嗽≥2周；任何症状；异常评分≥0.30或任何症状。我们计算了总实施成本、每例细菌学确诊病例的成本，并使用增量成本效益比（ICER）作为每增加一例病例的额外成本来评估成本效益。总体而言，共识别出3205例疑似结核病患者，对1021例进行了检测，检测出85例细菌学确诊的结核病患者。异常≥0.30或任何症状（65704美元）的成本最高，而咳嗽≥2周的成本最低（40740美元）。咳嗽≥2周时每例病例的成本为1198美元，任何症状时成本最低（635美元）。与咳嗽≥2周的基线策略相比，任何症状的ICER为每多检测出一例病例191美元，异常≥0.30或任何症状算法的ICER为2096美元。当无症状结核病占所有检测出的细菌学确诊结核病的比例高于30%时，使用CXR和AI检测每例病例的成本低于任何症状筛查标准。与传统症状筛查相比，将CXR和AI与症状结合使用能以更低的每例检测成本检测出更多病例，且具有成本效益。结核病项目应探索采用CXR和AI进行ACF筛查。
