Costs and cost-effectiveness of integrated screening for non-communicable diseases in TB contacts

Abstract

BACKGROUND: Integrating non-communicable disease (NCD) screening into TB household contact investigations may identify undiagnosed NCDs and reduce the burden of both conditions. However, evidence on the costs and cost-effectiveness of this approach is limited. METHOD: We conducted a cross-sectional study in South Africa to assess patient and provider costs for NCD screening (hypertension, diabetes, chronic kidney disease, dyslipidaemia). Incremental costs per NCD case identified were calculated. Using a decision tree model, we estimated incremental costs per disability-adjusted life year (DALY) averted over 10 years from a healthcare perspective, with cardiovascular disease (CVD) risk estimated using the WHO prediction model. RESULTS: The incremental cost was USD72.3 per contact screened and USD334.0 per NCD case identified. Integrated screening reduced mean 10-year CVD risk from 5.7% to 2.7% among contacts with NCDs. The incremental cost-effectiveness ratio (ICER) was USD27,043.6 per DALY averted, exceeding South Africa’s threshold of USD3,708. Management of identified NCDs, mainly drug costs, comprised over 80% of total incremental costs. The ICER decreased in populations with a high risk for NCDs. CONCLUSION: Integrated NCD screening was not cost-effective, mainly due to subsequent care costs. Prioritising individuals at high risk for NCDs can improve cost-effectiveness.