JMIR Publications

ABSTRACT

Background:

A mobile app calculated tuberculosis (TB) risk score by using individual socio pathology characteristics to identify the presumptive TB who has ≥0.5% probability to have TB.

Objective:

To find out the incremental cost effectiveness of active TB screening by the mobile app and chest x-ray (CXR) compared to routine passive screening by TB signs and symptoms (TBSS)

Methods:

Decision tree analysis was used to populate the cost and effectiveness of three initial screening strategies: routine TB screening by TBSS, active TB screenings by CXR, and mobile app. The probability distribution of TB case detection by each strategy was tested under the national TB prevalence of 468 per 100000 population in Myanmar. The operational costs were evaluated via a community-based TB screening. The effectiveness of TB screening was measured using disability-adjusted life years (DALY) averted. Incremental cost effectiveness ratio (ICER) (additional cost for additional DALY averted) was calculated against TBSS screening. The cost effectiveness threshold was set up at below 1467.604 USD gross domestic product per capita of the country.

Results:

The additional cost of active TB screening was 663677 USD in CXR, and 155541 in mobile app. The additional effectiveness was 576 DALY averted in CXR and 325 in mobile app. The ICER was 1152 USD in CXR and 478 in mobile app screenings. The probability of being cost effectiveness at the threshold was 92% in CXR and 100% in mobile app screening.

Conclusions:

In this endemic area, screening for adult TB using CXR with and without prior screening by the mobile app was cost effective. Adding the use of mobile app could reduce the cost of direct CXR by 76% (663677-155541/663677 USD), while missing >one third of DALY was averted (576-325/576 DALY). The mobile app system of social pathology characteristics for TB screening should be upscaled for a large trial.