Community-based mobile tuberculosis clinics in rural Madagascar

Impact and cost-effectiveness analysis

Bibliographic Data

ID21880967
AuthorsLukas Beigel (0000-0003-3999-3989, Humboldt-Universität zu Berlin), Hoa Thi Nguyen (0000-0002-4858-803X, Heidelberg University), Manuela De Allegri (0000-0002-8677-1337, Heidelberg University), Mara Anna Franke (0000-0001-7548-4423, Humboldt-Universität zu Berlin), Antsa Randrianantoanina (Doctors for Madagascar, Antananarivo, Madagascar), Fierenantsoa Ranjaharinony (Doctors for Madagascar, Antananarivo, Madagascar), Miandrisoa Etrahagnane (University of Toliara), Samuel Knauss (0000-0002-3046-9075, Heidelberg University), Julius Valentin Emmrich (Center for Global Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany), J Emmrich (0000-0002-3393-0840, Heidelberg University), Nadine Muller (0000-0001-8047-7180, Humboldt-Universität zu Berlin)
Year2025
Volume10
Issue10
Pagese019436
Publication date2025-10-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2025-019436
PMID41161733
OpenAlexW4415652978
LanguageEN
References cited20

INTRODUCTION: Tuberculosis (TB) remains an important public health challenge globally. Madagascar faces a substantial TB burden despite enhanced efforts from its national TB control programme. This necessitates innovative and context-specific TB prevention and care interventions that are both impactful and cost-effective. We evaluated the effectiveness and cost-effectiveness of a community-based mobile TB clinic intervention in a remote rural area of Madagascar, addressing specific access barriers and implementation challenges. METHODS: The analysis employed an interrupted time series analysis (ITSA) comparing the intervention to the standard national TB control programme (NTP) to assess the effectiveness of the intervention in increasing TB case detection rates. A decision tree model was used to evaluate the cost-effectiveness of the intervention from a healthcare provider perspective when compared with the NTP. The study incorporated one-way sensitivity analyses and Monte Carlo simulations with 10 000 iterations to generate the probability distribution of estimates and uncertainty ranges. RESULTS: The ITSA found that the intervention cumulatively increased TB case detection 2.88-fold compared with the control group over the 27-month study period. The probability for a patient to successfully complete TB treatment in the intervention group was 97%, compared with 91% in the control group. Incremental costs per person with TB were $316. With an incremental cost-effectiveness ratio (ICER) of $25 per disability-adjusted life year averted, well below the $96 cost effectiveness threshold for Madagascar, the intervention was highly cost-effective. Importantly, the ICER remained robust throughout sensitivity analyses, reaching a maximum of $67. CONCLUSION: The study underscores the importance of community-based interventions for TB and calls for policymakers to prioritise and scale up such interventions, both in Madagascar and in other low-income countries with similar access-related challenges

Developing country · Psychological intervention · Public health · Rural area · Tuberculosis · Global Maternal and Child Health · Healthcare Facilities Design and Sustainability · Tuberculosis Research and Epidemiology

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