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Now published in The Lancet

Cost-Effectiveness of Household Contact Investigation for the Detection of Tuberculosis in Vietnam: A Cluster Randomised Controlled Trial

19 Pages Posted: 30 Jun 2018

See all articles by Thomas Lung

Thomas Lung

University of Sydney - George Institute for Global Health; The University of Sydney - Faculty of Medicine and Health

Guy B. Marks

University of New South Wales (UNSW) - South Western Sydney Clinical School; The University of Sydney - Woolcock Institute of Medical Research

Nguyen Viet Nhung

National Lung Hospital; Hanoi Medical University

Nguyen Thu Anh

Hanoi Medical University

Nghiem Le Phuong Hoa

The University of Sydney - Woolcock Institute of Medical Research

Le Thi Ngoc Anh

The University of Sydney - Woolcock Institute of Medical Research

Nguyen Binh Hoa

National Lung Hospital; International Union Against Tuberculosis and Lung Disease (The Union) - Centre for Operational Research (COR)

Warwick John Britton

The University of Sydney - Faculty of Medicine and Health; The University of Sydney - Centenary Institute of Cancer Medicine and Cell Biology

Jessica Bestrashniy

The University of Sydney - Woolcock Institute of Medical Research

Stephen Jan

University of Sydney - George Institute for Global Health

Gregory J. Fox

The University of Sydney - Central Clinical School; The University of Sydney - Woolcock Institute of Medical Research

More...

Abstract

Background: Active case finding (ACF) is recommended as an important strategy to control tuberculosis (TB), particularly in high prevalence low- and middle- income (LMIC) settings. However, the costs and cost-effectiveness ACF have been uncertain, in the absence of evidence from randomised controlled trials (RCT). We investigated the cost-effectiveness of ACF in Vietnam based on the findings of a recent large-scale trial.

Methods: We conducted a pragmatic cluster RCT conducted in 70 districts in eight provinces of Vietnam, comparing ACF plus standard passive case finding (PCF) to PCF alone among the household contacts of patients with TB. In the intervention group, participants were invited to attend screening at baseline, 6, 12 and 24 months. Healthcare costs were determined using a standardised national costing survey. The primary outcome was DALYs averted over a 24-month period. Secondary outcomes were the cumulative incidence of registered and smear-positive cases of tuberculosis among contacts.

Findings: 10,069 and 15,638 household contacts were recruited to the intervention and control groups, respectively. The cost of ACF over a 24month period was $181 (95% CI 178 - 185) (2017 $USD) per person, compared to $83 (95% CI 83 - 83) per person for the control group. The incremental cost-effectiveness ratio was $544 (95% CI 330 - 1,375) per DALY averted.

Interpretation: ACF was shown to be highly cost-effective in a high prevalence setting. Investment in the wide-scale implementation of this programme in Vietnam, and comparable settings, should be strongly supported.

Funding: Australian National Health and Medical Research Council

Declaration of Interests: There are no conflicts of interest to disclose

Ethics approval was provided by the Human Research Ethics Committee at the University of Sydney and the Scientific Committee of the Vietnam Ministry of Health. The trial was registered prospectively with the Australian and New Zealand Clinical Trials Registry (ACTRN 12610000600044).

Keywords: cost-effectiveness, tuberculosis, active case finding

Suggested Citation

Lung, Thomas and Marks, Guy B. and Nhung, Nguyen Viet and Anh, Nguyen Thu and Hoa, Nghiem Le Phuong and Anh, Le Thi Ngoc and Hoa, Nguyen Binh and Britton, Warwick John and Bestrashniy, Jessica and Jan, Stephen and Fox, Gregory J., Cost-Effectiveness of Household Contact Investigation for the Detection of Tuberculosis in Vietnam: A Cluster Randomised Controlled Trial (June 29, 2018). Global Health, Volume 7, Issue 3, E376-E384, March 01, 2019, https://doi.org/10.1016/S2214-109X(18)30520-5, Available at SSRN: https://ssrn.com/abstract=3205748 or http://dx.doi.org/10.2139/ssrn.3205748

Thomas Lung (Contact Author)

University of Sydney - George Institute for Global Health ( email )

Level 10, King George V Building
83-117 Missenden Rd
Camperdown, NSW 2050
Australia

The University of Sydney - Faculty of Medicine and Health

Sydney, New South Wales 2006
Australia

Guy B. Marks

University of New South Wales (UNSW) - South Western Sydney Clinical School

Liverpool, New South Wales 2170
Australia

The University of Sydney - Woolcock Institute of Medical Research

431 Glebe Point Road
Glebe, New South Wales 2037
Australia

Nguyen Viet Nhung

National Lung Hospital

463 Hoàng Hoa Thám
Hanoi
Vietnam

Hanoi Medical University

1 Tôn Thất Tùng
Hanoi
Vietnam

Nguyen Thu Anh

Hanoi Medical University ( email )

Hanoi
Vietnam

Nghiem Le Phuong Hoa

The University of Sydney - Woolcock Institute of Medical Research

431 Glebe Point Road
Glebe, New South Wales 2037
Australia

Le Thi Ngoc Anh

The University of Sydney - Woolcock Institute of Medical Research

431 Glebe Point Road
Glebe, New South Wales 2037
Australia

Nguyen Binh Hoa

National Lung Hospital

463 Hoàng Hoa Thám
Hanoi
Vietnam

International Union Against Tuberculosis and Lung Disease (The Union) - Centre for Operational Research (COR)

Paris, 75006
France

Warwick John Britton

The University of Sydney - Faculty of Medicine and Health

Sydney, New South Wales 2006
Australia

The University of Sydney - Centenary Institute of Cancer Medicine and Cell Biology

Royal Prince Alfred Hospital
Missenden Rd, Building 93
Camperdown, New South Wales 2050
Australia

Jessica Bestrashniy

The University of Sydney - Woolcock Institute of Medical Research

431 Glebe Point Road
Glebe, New South Wales 2037
Australia

Stephen Jan

University of Sydney - George Institute for Global Health ( email )

Sydney
Australia

Gregory J. Fox

The University of Sydney - Central Clinical School ( email )

Sydneyy, NSW
Australia

The University of Sydney - Woolcock Institute of Medical Research

431 Glebe Point Road
Glebe, New South Wales 2037
Australia