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. 2011 Sep 14:343:d5376.
doi: 10.1136/bmj.d5376.

Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation

Mark Jit  1 , Helen R Stagg, Robert W Aldridge, Peter J White, Ibrahim Abubakar; Find and Treat Evaluation Team
Collaborators, Affiliations

Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation

Mark Jit et al. BMJ. .

Abstract

Objective: To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis.

Design: Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis.

Setting: London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London's enhanced tuberculosis surveillance system.

Main outcome measures: Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service.

Results: The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10,000/QALY gained (about €7300-€11,000 or $10,000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18,000-£26,000/QALY gained; case management support team, £4100-£6800/QALY gained).

Conclusions: Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: this work was funded by the English Department of Health, Medical Research Council, and National Institute for Health Research; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Health states in compartmental model for active tuberculosis cases, managed by the Find and Treat service
See this image and copyright information in PMC

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