Costs and cost-effectiveness of integrated screening for non-communicable diseases in TB contacts

Background Integrating non-communicable disease (NCD) screening into TB household contact investigations may identify undiagnosed NCDs and reduce the burden of both conditions. However, evidence on the costs and cost-effectiveness of this approach is limited. Method We conducted a cross-sectional study in South Africa to assess patient and provider costs for NCD screening (hypertension, diabetes, chronic kidney disease, dyslipidaemia). Incremental costs per NCD case identified were calculated. Using a decision tree model, we estimated incremental costs per disability-adjusted life year (DALY) averted over 10 years from a healthcare perspective, with cardiovascular disease (CVD) risk estimated using the WHO prediction model. Results The incremental cost was USD72.3 per contact screened and USD334.0 per NCD case identified. Integrated screening reduced mean 10-year CVD risk from 5.7% to 2.7% among contacts with NCDs. The incremental cost-effectiveness ratio (ICER) was USD27,043.6 per DALY averted, exceeding South Africa's threshold of USD3,708. Management of identified NCDs, mainly drug costs, comprised over 80% of total incremental costs. The ICER decreased in populations with a high risk for NCDs. Conclusion Integrated NCD screening was not cost-effective, mainly due to subsequent care costs. Prioritising individuals at high risk for NCDs can improve cost-effectiveness.