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Base case tuberculosis prevalence was 0.64%\u20131.23%. Sensitivity\/specificity\/cost for dCXR\/CAD were 77%\u201390%\/65%\u201373%\/$3.55; for Xpert Ultra, they were 69%\u201391%\/98%\u201399%\/$15.24. Model outcomes included life-years, costs, and incremental cost-effectiveness ratios (ICERs) (&amp;lt;$3000\/year-of-life saved [YLS] considered cost-effective). We conducted sensitivity analysis around key parameters, including test sensitivity, specificity, and cost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>In the base case, Xpert identifies the most individuals with tuberculosis but produces the most false positives and highest costs. Compared to Xpert, dCXR\u2009+\u2009Xpert identifies \u223c13% fewer individuals with tuberculosis while decreasing screening costs by \u223c45%. Given base case performance characteristics, at the lifetime horizon, dCXR\u2009+\u2009Xpert is cost-effective (ICER $610\/YLS) whereas Xpert is not (ICER $3460\/YLS). dCXR\u2009+\u2009Xpert remains cost-effective relative to No Screening, unless tuberculosis prevalence (PWoH\/PWH) is\u2009\u22640.15%\/0.45%, dCXR\/CAD sensitivity is (PWoH\/PWH)\u2009\u2264\u200920%\/10%, dCXR\/CAD cost is \u2265$34.00, Xpert Ultra cost is \u2265$135.00, or linkage to tuberculosis care is\u2009\u226415%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Digital chest radiography with computer-aided detection followed by confirmatory sputum Xpert Ultra would likely be a cost-effective strategy for tuberculosis screening in South Africa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamag163","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T12:48:40Z","timestamp":1774702120000},"page":"1793-1805","source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness of community tuberculosis screening in South Africa"],"prefix":"10.1093","volume":"212","author":[{"given":"Julie N","family":"Deleger","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Nazanin","family":"Khatami","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Institute for Technology Assessment, Massachusetts General Hospital , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2416-5769","authenticated-orcid":false,"given":"Michelle","family":"Jones","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6769-2732","authenticated-orcid":false,"given":"Mohammad S","family":"Jalali","sequence":"additional","affiliation":[{"name":"Institute for Technology Assessment, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A David","family":"Paltiel","sequence":"additional","affiliation":[{"name":"Public Health Modeling Unit, Yale School of Public Health , New Haven, CT,","place":["United States"]},{"name":"Department of Health Policy and Management, Yale School of Public Health , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4755-5380","authenticated-orcid":false,"given":"Emily B","family":"Wong","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , Durban,","place":["South Africa"]},{"name":"University of Alabama at Birmingham Heersink School of Medicine, , Birmingham, AL,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grady","family":"Florance","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A","family":"Freedberg","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA,","place":["United States"]},{"name":"Divison of General Internal Medicine, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Department of Health Policy and Management, Harvard T.H. 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