Active Case Finding for Tuberculosis in India: A Cost-Effectiveness Analysis
Ranjani Ramachandran, Pranay Lal, Sanjay Jha
PLOS ONE · 2020 · DOI: 10.1371/journal.pone.0234735
Countries: India
What Was Studied
A cost-effectiveness modelling study comparing passive case finding (patients present to health facilities) versus active case finding (health workers screen communities) for tuberculosis in high-burden districts of India, using data from pilot programmes in 4 states.
What They Found
Active case finding was cost-effective at $340 per DALY averted, well below the WHO threshold. It identified 18% more TB cases than passive detection alone and reduced diagnostic delays from 60 to 21 days. The strategy was most cost-effective when targeted at high-risk populations: urban slums, contacts of known cases, and populations with HIV co-infection. Door-to-door screening was less cost-effective than targeted camp-based screening in high-prevalence areas.
What This Means for Nepal
Nepal's National TB Programme could adopt targeted active case finding in high-burden districts, particularly in the Terai where cross-border movement with India creates ongoing transmission. The evidence supports camp-based screening in high-prevalence areas over expensive door-to-door approaches. Nepal's FCHV network could be leveraged for TB symptom screening referrals, making the strategy even more cost-effective by using existing community infrastructure.
Contextualisation
Nepal shares a similar TB burden and epidemiological profile with neighbouring India. Active case finding strategies proven cost-effective in India's high-burden states are directly applicable to Nepal's TB control programme, especially in the Terai region with cross-border population movement.