{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:23:32Z","timestamp":1768569812091,"version":"3.49.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.<\/jats:p>","DOI":"10.3389\/fpubh.2021.699735","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T04:38:00Z","timestamp":1626064680000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Cost-Effectiveness Analysis of High-Risk Groups Tuberculosis Screening in Malaysia"],"prefix":"10.3389","volume":"9","author":[{"given":"Nor Zam Azihan","family":"Mohd Hassan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asmah","family":"Razali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohd Ridzwan","family":"Shahari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohd Shaiful Jefri","family":"Mohd Nor Sham Kunusagaran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juanita","family":"Halili","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nur Amalina","family":"Zaimi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohd Shahri","family":"Bahari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farhana","family":"Aminuddin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"B1","unstructured":"GenevaWorld Health OrganizationGlobal Tuberculosis Report 20192019"},{"key":"B2","doi-asserted-by":"publisher","first-page":"335","DOI":"10.2147\/CEOR.S92244","article-title":"Screening strategies for active tuberculosis: focus on cost-effectiveness","volume":"8","author":"Dobler","year":"2016","journal-title":"Clin Econ Outcomes Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1459","DOI":"10.5588\/ijtld.14.0271","article-title":"Screening for active tuberculosis in high-risk groups","volume":"18","author":"Jim\u00e9nez-Fuentes","year":"2014","journal-title":"Int J Tuberc Lung Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"573","DOI":"10.5588\/ijtld.12.0920","article-title":"Active case finding for tuberculosis among high-risk groups in low-incidence countries","volume":"17","author":"Zenner","year":"2013","journal-title":"Int J Tuberc Lung Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"75","DOI":"10.5588\/ijtld.11.0075","article-title":"Bleach treatment of sputum samples aids pulmonary tuberculosis screening among HIV-infected patients in Laos","volume":"15","author":"Thammavong","year":"2011","journal-title":"Int J Tuberc Lung Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.jval.2017.09.003","article-title":"Cost of tuberculosis diagnosis and treatment in patients with HIV: a systematic literature review","volume":"21","author":"de","year":"2018","journal-title":"Value Health"},{"key":"B7","unstructured":"PutajayaMOHMalaysia National Strategic Plan for Tuberculosis Control (2016\u20132020)2016"},{"key":"B8","volume-title":"urat Pekeliling KPK Bil 1 2016 - Pengukuhan Saringan Golongan Berisoko Tinggi Tuberculosis (Tibi) di bawah Program Kawalan Tibi Kebangsaan KKM -.pdf","year":"2016"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0124116","DOI":"10.1371\/journal.pone.0124116","article-title":"Cost-effectiveness of screening and treating foreign-born students for tuberculosis before entering the United States","volume":"10","author":"Wingate","year":"2015","journal-title":"PLoS ONE"},{"key":"B10","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1097\/QAD.0b013e3283522d47","article-title":"The cost-effectiveness of routine tuberculosis screening with Xpert MTB\/RIF prior to initiation of antiretroviral therapy","volume":"26","author":"Andrews","year":"2012","journal-title":"AIDS"},{"key":"B11","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/1471-2458-13-97","article-title":"Target prioritization and strategy selection for active case-finding of pulmonary tuberculosis: a tool to support country-level project planning","volume":"13","author":"Nishikiori","year":"2013","journal-title":"BMC Public Health"},{"key":"B12","first-page":"11","article-title":"Associated factors for positive CXR among TB high risk group screening in kedah unmet health need among elderly with diabetes in Penang: a mixed method study view project","volume":"4","author":"Ahmad Hanis","year":"2019","journal-title":"J Biomed Clin Sci"},{"key":"B13","doi-asserted-by":"publisher","first-page":"27","DOI":"10.2471\/BLT.16.169383","article-title":"Cost-effectiveness of screening for active cases of tuberculosis in flanders, Belgium","volume":"95","author":"Smit","year":"2017","journal-title":"Bull World Health Org"},{"key":"B14","doi-asserted-by":"publisher","first-page":"432","DOI":"10.5588\/ijtld.12.0743","article-title":"The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review","volume":"17","author":"Kranzer","year":"2013","journal-title":"Int J Tuberc Lung Dis"},{"key":"B15","unstructured":"Exchange Rates2021"},{"key":"B16","unstructured":"Macroeconomics and Health: Investing in Health for Economic Development: Executive Summary\/Report of the Commission on Macroeconomics and Health2001"},{"key":"B17","doi-asserted-by":"publisher","first-page":"118","DOI":"10.2471\/BLT.14.138206","article-title":"Thresholds for the cost-effectiveness of interventions: alternative approaches","volume":"93","author":"Marseille","year":"2015","journal-title":"Bull World Health Org"},{"key":"B18","unstructured":"GDP per Capita, Current Prices2018"},{"key":"B19","volume-title":"Management of Tuberculosis","year":"2012"},{"key":"B20","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1177\/0962280211419832","article-title":"Probabilistic sensitivity analysis in health economics","volume":"24","author":"Baio","year":"2015","journal-title":"Stat Methods Med Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"iii","DOI":"10.3310\/hta13290","article-title":"Sensitivity analysis in economic evaluation: an audit of NICE current practice and a review of its use and value in decision-making","volume":"13","author":"Andronis","year":"2009","journal-title":"Health Technol Assess"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e163","DOI":"10.1016\/S2214-109X(18)30564-3","article-title":"Costs of tuberculosis screening among inpatients with HIV","volume":"7","author":"Zwerling","year":"2019","journal-title":"Lancet Global Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e0165614","DOI":"10.1371\/journal.pone.0165614","article-title":"Cost-effectiveness of community-based TB\/HIV screening and linkage to care in rural South Africa","volume":"11","author":"Gilbert","year":"2016","journal-title":"PLoS ONE"},{"key":"B24","unstructured":"145Country Progress Report on HIV\/AIDS2018"},{"key":"B25","unstructured":"151\n            MiglioriGB\n            AmbrosioLD\n            CentisR\n            van den BoomM\n            EhsaniS\n            DaraM\n          WHOGuiding Principles to Reduce Tuberculosis Transmission in the WHO European Region2018"},{"key":"B26","unstructured":"189226CDC Infectious Control"},{"key":"B27","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1093\/ije\/28.3.563","article-title":"Cost-effectiveness of screening compared to case-finding approaches to tuberculosis in long term care facilities for the elderly","volume":"28","author":"Marchand","year":"1999","journal-title":"Int J Epidemiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"261","DOI":"10.4046\/trd.2019.0043","article-title":"Active case finding in the elderly tuberculosis in South Korea","volume":"82","author":"Lee","year":"2019","journal-title":"Tuberc Resp Dis"},{"key":"B29","doi-asserted-by":"publisher","first-page":"7","DOI":"10.5588\/ijtld.17.0329","article-title":"Tuberculosis and diabetes in low and moderate tuberculosis incidence countries","volume":"22","author":"Lee","year":"2018","journal-title":"Int J Tuberc Lung Dis"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e1002072","DOI":"10.1371\/journal.pmed.1002072","article-title":"Glycemic control and the risk of tuberculosis: a cohort study","volume":"13","author":"Lee","year":"2016","journal-title":"PLoS Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.ijid.2020.01.019","article-title":"Screening for pulmonary tuberculosis in high-risk groups of diabetic patients","volume":"93","author":"Ji","year":"2020","journal-title":"Int J Infect Dis"},{"key":"B32","first-page":"17","article-title":"Risk factors associated with recent transmission of tuberculosis: systematic review and meta-analysis","volume":"13","author":"Nava-Aguilera","year":"2009","journal-title":"Int J Tuberc Lung Dis"},{"key":"B33","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.jsat.2013.08.023","article-title":"Tuberculosis screening in a novel substance abuse treatment center in Malaysia: implications for a comprehensive approach for integrated care","volume":"46","author":"Al-Darraji","year":"2014","journal-title":"J Subs Abuse Treat"},{"key":"B34","volume-title":"Disease Control Priorities in Developing Countries","author":"Jamison","year":"2006"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e816","DOI":"10.1016\/S2214-109X(16)30265-0","article-title":"Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models","volume":"4","author":"Menzies","year":"2016","journal-title":"Lancet Global Health"},{"key":"B36","doi-asserted-by":"publisher","first-page":"4869","DOI":"10.1038\/s41598-019-41256-4","article-title":"Mathematical modelling of the impact of treating latent tuberculosis infection in the elderly in a city with intermediate tuberculosis burden","volume":"9","author":"Chong","year":"2019","journal-title":"Sci Rep."},{"key":"B37","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s13690-020-00472-5","article-title":"Decomposition of years of life lost due to premature death (YLL): a method for spatial and temporal comparative assessment","volume":"78","author":"Saxena","year":"2020","journal-title":"Arch Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.699735\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T04:38:08Z","timestamp":1626064688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.699735\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,12]]},"references-count":37,"alternative-id":["10.3389\/fpubh.2021.699735"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.699735","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,12]]},"article-number":"699735"}}