The cost effectiveness and impact of an optimised TB diagnosis intervention on incidence, prevalence and mortality due to TB in Malawi. (360G-Wellcome-218333_Z_19_Z)

Early diagnosis of tuberculosis (TB) reduces transmission thus impacting TB incidence and prevalence. Research undertaken in developing countries shows that current TB diagnosis algorithms act as a barrier to poorer people seeking TB diagnosis and treatment. Patients accessing these services may incur catastrophic costs therefore hindering the achievement of WHO’s target of 0% incidence of catastrophic costs due to TB. This has led to concerted efforts to develop interventions that simplify TB diagnosis and treatment pathways. In Blantyre, Malawi, one such intervention based on computer-aided x-ray diagnosis (TB-CAD) is currently being investigated in the PROSPECT study, a randomised controlled trial. My research will investigate the public health benefits and cost-effectiveness, – from the health provider and societal perspective – of TB-CAD. By fitting statistical models using the PROSPECT study’s trial data, I will estimate the long-term impact on TB prevalence, incidence and mortality in Malawi, assuming that TB-CAD were to be scaled-up at country-level. I will additionally estimate whether the health benefits and reduction in costs are equally distributed between the poorest and the least poor in society. These data will provide policymakers with evidence for whether TB-CAD offers a cost-effective and equitable approach to reversing TB epidemics in Malawi.