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Programmatic Cost-Effectiveness of a Second-Time Visit to Detect New Tuberculosis and Diabetes Mellitus in TB Contact Tracing in Myanmar

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  • Nyi Nyi Zayar

    (Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand)

  • Rassamee Chotipanvithayakul

    (Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand)

  • Kyaw Ko Ko Htet

    (Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand)

  • Virasakdi Chongsuvivatwong

    (Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand)

Abstract

Background: Integration of diabetes mellitus screening in home visits for contact tracing for tuberculosis could identify hidden patients with either tuberculosis or diabetes mellitus. However, poor compliance to the first home screening has been reported. A second time visit not only increases screening compliance but also the cost. This study aimed to determine if an additional second time visit was cost effective based on the health system perspective of the tuberculosis contact tracing program in Myanmar. Methods: This cross-sectional study was based on usual contact tracing activity in the Yangon Region, Myanmar, from April to December 2018 with integration of diabetes mellitus screening and an additional home visit to take blood glucose tests along with repeated health education and counseling to stress the need for a chest X-ray. New tuberculosis and diabetes mellitus cases detected were the main outcome variables. Programmatic operational costs were calculated based on a standardized framework for cost evaluation on tuberculosis screening. The effectiveness of an additional home visit was estimated using disability-adjusted life years averted. The willingness to pay threshold was taken as 1250.00 US dollars gross domestic product per capita of the country. Results: Single and additional home visits could lead to 42.5% and 65.0% full compliance and 27.2 and 9.3 additional years of disability-adjusted life years averted, respectively. The respective base costs and additional costs were 3280.95 US dollars and 1989.02 US dollars. The programmatic costs for an extra unit of disability-adjusted life years averted was 213.87 US dollars, which was lower than the willingness to pay threshold. Conclusions: From the programmatic perspective, conducting the second time visit for tuberculosis contact tracing integrated with diabetes mellitus screening was found to be cost effective.

Suggested Citation

  • Nyi Nyi Zayar & Rassamee Chotipanvithayakul & Kyaw Ko Ko Htet & Virasakdi Chongsuvivatwong, 2022. "Programmatic Cost-Effectiveness of a Second-Time Visit to Detect New Tuberculosis and Diabetes Mellitus in TB Contact Tracing in Myanmar," IJERPH, MDPI, vol. 19(23), pages 1-12, December.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:23:p:16090-:d:990635
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    References listed on IDEAS

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    2. Gray, Alastair M. & Clarke, Philip M. & Wolstenholme, Jane L. & Wordsworth, Sarah, 2010. "Applied Methods of Cost-effectiveness Analysis in Healthcare," OUP Catalogue, Oxford University Press, number 9780199227280.
    3. Anna Vassall & Sanne van Kampen & Hojoon Sohn & Joy S Michael & K R John & Saskia den Boon & J Lucian Davis & Andrew Whitelaw & Mark P Nicol & Maria Tarcela Gler & Anar Khaliqov & Carlos Zamudio & Mar, 2011. "Rapid Diagnosis of Tuberculosis with the Xpert MTB/RIF Assay in High Burden Countries: A Cost-Effectiveness Analysis," PLOS Medicine, Public Library of Science, vol. 8(11), pages 1-14, November.
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