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

Jit, M; Stagg, HR; Aldridge, RW; White, PJ; Abubakar, I; Find and Treat Evaluation Team, ; (2011) Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation. British Medical Journal , 343 , Article d5376. 10.1136/bmj.d5376. Green open access

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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.

Type: Article
Title: Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmj.d5376
Publisher version: http://dx.doi.org/10.1136/bmj.d5376
Language: English
Additional information: This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
Keywords: Antitubercular Agents, Cohort Studies, Cost-Benefit Analysis, Health Care Costs, Health Services Accessibility, Humans, London, Mass Screening, Mobile Health Units, Observation, Program Evaluation, Quality of Life, Referral and Consultation, Retrospective Studies, Tuberculosis, Pulmonary
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/1354069
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