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Treatment decision algorithms for tuberculosis screening and diagnosis in children below 5 years hospitalised with severe acute malnutrition: a cost-effectiveness analysis

dc.rights.licenseopenen_US
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorD'ELBEE, Marc
dc.contributor.authorMAFIRAKUREVA, Nyashadzaishe
dc.contributor.authorCHABALA, Chishala
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorHUYEN TON NU NGUYET, Minh
dc.contributor.authorHARKER, Martin
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorROUCHER, Clementine
dc.contributor.authorBUSINGE, Gerald
dc.contributor.authorSHANKALALA, Perfect
dc.contributor.authorNDUNA, Bwendo
dc.contributor.authorMULENGA, Veronica
dc.contributor.authorBONNET, Maryline
dc.contributor.authorWOBUDEYA, Eric
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorMARCY, Olivier
dc.contributor.authorDODD, Peter J
dc.date.accessioned2025-07-09T14:40:44Z
dc.date.available2025-07-09T14:40:44Z
dc.date.issued2025-05-01
dc.identifier.issn2589-5370en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/207283
dc.description.abstractEnBACKGROUND: Children with severe acute malnutrition (SAM) are an important risk group for underdiagnosis and death from tuberculosis. In 2022, the World Health Organization (WHO) recommended use of treatment decision algorithms (TDAs) for tuberculosis diagnosis in children. There is currently no cost-effectiveness evidence for TDA-based approaches compared to routine practice. METHODS: The TB-Speed SAM study developed i) a one-step TDA including Xpert, clinical, radiological and echography features, and ii) a two-step TDA, which also included a screening phase, for children under 5 years hospitalised with SAM at three tertiary hospitals in Uganda and Zambia from 4th November 2019 to 20th June 2022. This study is registered with ClinicalTrials.gov, NCT04240990. We assessed the diagnostic accuracy and cost-effectiveness of deploying TB-Speed and WHO TDA-based approaches compared to the standard of care (SOC). Estimated outcomes included children started on tuberculosis treatment, false positive rates, disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs). FINDINGS: Per 100 children hospitalised with SAM, averaging 19 children with tuberculosis, the one-step TDA initiated 17 true positive children (95% uncertainty intervals [UI]: 12-23) on tuberculosis treatment, the two-step TDA 15 (95%UI: 10-22), the WHO TDA 14 (95%UI: 9-19), and SOC 4 (95%UI: 2-9). The WHO TDA generated the most false positives (35, 95%UI: 24-46), followed by the one-step TDA (18, 95%UI: 6-29), the two-step TDA (14, 95%UI: 1-25), and SOC (11, 95%UI: 3-17). All TDA-based approaches had ICERs below plausible country cost-effectiveness thresholds compared to SOC (one-step: $44-51/DALY averted, two-step: $34-39/DALY averted, WHO: $40-46/DALY averted). INTERPRETATION: Our findings show that these TDA-based approaches are highly cost-effective for the vulnerable group of children hospitalised with SAM, compared to current practice. FUNDING: Unitaid Grant number: 2017-15-UBx-TB-SPEED.
dc.language.isoENen_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subject.enCost-effectiveness analysis
dc.subject.enDiagnosis
dc.subject.enLow- and middle-income countries
dc.subject.enPaediatric tuberculosis
dc.subject.enSevere acute malnutrition
dc.subject.enTreatment decision algorithms
dc.title.enTreatment decision algorithms for tuberculosis screening and diagnosis in children below 5 years hospitalised with severe acute malnutrition: a cost-effectiveness analysis
dc.title.alternativeEClinicalMedicineen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1016/j.eclinm.2025.103206en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed40291345en_US
bordeaux.journalEClinicalMedicineen_US
bordeaux.page103206en_US
bordeaux.volume83en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamGHIGS_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.identifier.funderIDInstitut de Recherche pour le Développementen_US
hal.identifierhal-05154834
hal.version1
hal.date.transferred2025-07-09T14:40:47Z
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=EClinicalMedicine&rft.date=2025-05-01&rft.volume=83&rft.spage=103206&rft.epage=103206&rft.eissn=2589-5370&rft.issn=2589-5370&rft.au=D'ELBEE,%20Marc&MAFIRAKUREVA,%20Nyashadzaishe&CHABALA,%20Chishala&HUYEN%20TON%20NU%20NGUYET,%20Minh&HARKER,%20Martin&rft.genre=article


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