Abstract / Summary
Abstract Objective This study evaluated the costs and cost-effectiveness of active case-finding strategies for detecting asymptomatic tuberculosis among close contacts of active tuberculosis patients in China using a Markov model, with the aim of informing the optimization of tuberculosis screening strategies. Methods A decision tree combined with a Markov model was developed from the healthcare system perspective to compare four screening strategies among close contacts of active tuberculosis patients: passive case finding, chest radiography with human interpretation, chest radiography assisted by computer-aided detection, and pooled GeneXpert testing. A hypothetical cohort was simulated over a 20-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) gained. Strategies were evaluated against China’s willingness-to-pay (WTP) threshold of ¥298,995 per quality-adjusted life year. Results Active case-finding strategies reduced tuberculosis cases and deaths compared with passive case finding.. Pooled GeneXpert testing produced the greatest health benefit, reducing surviving tuberculosis cases by 3,738 and cumulative deaths by 812 per 100,000 close contacts compared with passive case finding. Compared with chest radiography assisted by computer-aided detection, pooled GeneXpert testing achieved an incremental cost-effectiveness ratio of ¥1,117.40 per quality-adjusted life year gained, well below the willingness-to-pay threshold. Conclusion Pooled GeneXpert testing was the most cost-effective strategy for detecting asymptomatic tuberculosis among close contacts in China, while computer-aided chest radiography may serve as a low-cost alternative in resource-limited settings.