Diabetes Screening Strategies for people with TB in public health facilities, Gauteng, South Africa: cost-effectiveness analysis
1
Department of Health, eKurhuleni, South Africa
2
University of Free state, Bloemfontein, South Africa
3
Gauteng, Department of Health, Gauteng, South Africa
4
Diabetes Research Centre, The University of Pretoria, Pretoria, South Africa
5
Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa
6
CDC Foundation, Atlanta, United States
Popul. Med. 2026;8(Supplement Supplement 1):A2979
ABSTRACT
BACKGROUND:
People with TB (PWTB) and uncontrolled diabetes (DM) comorbidity, have worse TB treatment outcomes and 2-4 times higher mortality rates, than those without DM or with controlled DM. Despite this important association, DM diagnostic coverage among PWTB in South Africa (SA) is estimated at only 38.5%. We aimed to compare three potential DM screen, diagnose and treat strategies among people with active TB within public health facilities in Gauteng, SA: a) Strategy one: the status quo; b) Strategy two: screen, diagnose and treat all; c) Strategy three: targeted DM screen, diagnose and treat for those above 45 years of age.
METHODS:
We used a cost-effective analysis study design. Our data sources included epidemiological studies retrieved from electronic databases and supplementary costing data sourced from the South African Department of Health and the National Health Laboratory Service. We developed a decision tree to simulate the effects of each screening strategy in terms of health impact and cost-effectiveness outcomes. We assumed a two-year time horizon with cost discounting at 3.5%.
RESULTS:
Estimated costs for each strategy were $18 799, $336 893, $120 931 for strategies one, two and three, respectively. Implementing strategy two and three, versus the status quo, averted 321 and 247 deaths, respectively. The cost per death averted, using status quo as the baseline, were $993 for strategy two and $414 for strategy three.
CONCLUSIONS:
At a willingness to pay a threshold of $25 555 (R460 000) per death averted, DM screening for all PWTB within public health facilities in Gauteng is a cost-effective strategy, that could improve DM diagnostic coverage among people with TB, and avert TB-related deaths. These findings can assist policymakers' decisions for integrating DM screening algorithms into TB care in public health facilities in Gauteng, South Africa, with a view to national rollout.
People with TB (PWTB) and uncontrolled diabetes (DM) comorbidity, have worse TB treatment outcomes and 2-4 times higher mortality rates, than those without DM or with controlled DM. Despite this important association, DM diagnostic coverage among PWTB in South Africa (SA) is estimated at only 38.5%. We aimed to compare three potential DM screen, diagnose and treat strategies among people with active TB within public health facilities in Gauteng, SA: a) Strategy one: the status quo; b) Strategy two: screen, diagnose and treat all; c) Strategy three: targeted DM screen, diagnose and treat for those above 45 years of age.
METHODS:
We used a cost-effective analysis study design. Our data sources included epidemiological studies retrieved from electronic databases and supplementary costing data sourced from the South African Department of Health and the National Health Laboratory Service. We developed a decision tree to simulate the effects of each screening strategy in terms of health impact and cost-effectiveness outcomes. We assumed a two-year time horizon with cost discounting at 3.5%.
RESULTS:
Estimated costs for each strategy were $18 799, $336 893, $120 931 for strategies one, two and three, respectively. Implementing strategy two and three, versus the status quo, averted 321 and 247 deaths, respectively. The cost per death averted, using status quo as the baseline, were $993 for strategy two and $414 for strategy three.
CONCLUSIONS:
At a willingness to pay a threshold of $25 555 (R460 000) per death averted, DM screening for all PWTB within public health facilities in Gauteng is a cost-effective strategy, that could improve DM diagnostic coverage among people with TB, and avert TB-related deaths. These findings can assist policymakers' decisions for integrating DM screening algorithms into TB care in public health facilities in Gauteng, South Africa, with a view to national rollout.
| eISSN: | 2654-1459 |
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