Young Neenah, Biché Patrick, Mohlamonyane Mbali, Morolo Matshidiso, Maholwana Babalwa, Ahmed Khatija, Martinson Neil, Hanrahan Colleen F, Dowdy David W
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa.
EClinicalMedicine. 2025 May 26;84:103259. doi: 10.1016/j.eclinm.2025.103259. eCollection 2025 Jun.
Household contact investigation (HCI) for tuberculosis (TB) is recommended but often limited by resource constraints, particularly for individuals unavailable during business hours.
We conducted an economic evaluation from January 1, 2022, through December 31, 2022, nested within a randomized trial in South Africa ("Kharituwe") comparing standard HCI for TB and two novel strategies: HCI during holiday periods in a rural setting and off-peak HCI during weekends and evenings in an urban setting. Costs were derived from 2022 expenditures, and secondary TB cases were defined by positive sputum cultures. As a secondary outcome of the Kharituwe Study, we assessed the incremental cost-effectiveness ratio (ICER) of each strategy against a hypothetical no-HCI scenario from the health system perspective in 2022 US dollars. Cost-effectiveness was assessed using a country-specific willingness-to-pay threshold of US$3015 per disability-adjusted life year (DALY) averted. The trial is registered with clincaltrials.gov (NCT04520113).
Relative to a hypothetical no-HCI approach, standard HCI was estimated to cost US$1400 [95% uncertainty interval (UI): $1000-$2100] per DALY averted in the urban setting and US$3600 [95% UI: $2500-$5400] in the rural setting. Corresponding cost-effectiveness ratios were US$1900 [95% UI: $1300-$2800] for off-peak (urban) and US$6400 [$3900-$10,000] for holiday-based (rural) HCI. Personnel costs, travel costs (in the rural setting), and TB prevalence among contact persons were primary drivers of cost-effectiveness.
HCI for TB is likely cost-effective in urban South Africa and may be cost-effective in rural settings, which face barriers including long travel times and lower TB prevalence. Holiday-based HCI was not found to be cost-effective. Integrating HCI for TB into broader home-based interventions may improve cost-effectiveness.
Funding was provided by the United States National Institute of Allergy and Infectious Diseases (Grant # 5R01AI147681).
推荐对结核病（TB）进行家庭接触者调查（HCI），但该调查往往受到资源限制，特别是对于在工作时间无法找到的个体。
我们于2022年1月1日至2022年12月31日进行了一项经济评估，该评估嵌套在南非的一项随机试验（“Kharituwe”）中，比较了结核病的标准家庭接触者调查和两种新策略：农村地区节假日期间的家庭接触者调查以及城市地区周末和晚上非高峰时段的家庭接触者调查。成本来自2022年的支出，继发性结核病例通过痰培养阳性来定义。作为Kharituwe研究的次要结果，我们从卫生系统角度，以2022年美元为单位，评估了每种策略相对于假设的无家庭接触者调查方案的增量成本效益比（ICER）。使用特定国家的意愿支付阈值，即每避免一个伤残调整生命年（DALY）3015美元来评估成本效益。该试验已在clinicaltrials.gov注册（NCT04520113）。
相对于假设的无家庭接触者调查方法，估计在城市环境中，标准家庭接触者调查每避免一个DALY的成本为1400美元[95%不确定区间（UI）：1000 - 2100美元]，在农村环境中为3600美元[95% UI：2500 - 5400美元]。非高峰时段（城市）和基于节假日的（农村）家庭接触者调查的相应成本效益比分别为1900美元[95% UI：1300 - 2800美元]和6400美元[3900 - 10000美元]。人员成本、差旅成本（农村地区）以及接触者中的结核病患病率是成本效益的主要驱动因素。
在南非城市地区，结核病家庭接触者调查可能具有成本效益，在农村地区可能也具有成本效益，农村地区面临包括出行时间长和结核病患病率较低等障碍。未发现基于节假日的家庭接触者调查具有成本效益。将结核病家庭接触者调查纳入更广泛的家庭干预措施可能会提高成本效益。
由美国国家过敏和传染病研究所提供资助（资助编号# 5R01AI147681）。
