Potential impact, costs, and benefits of population-wide screening interventions for tuberculosis in Viet Nam: A mathematical modelling study

Alvaro Schwalb; Katherine C Horton; Jon C Emery; Martin J Harker; Lara Goscé; Lara D Veeken; Frances L Garden; Hai Viet Nguyen; Thu-Anh Nguyen; Khanh Luu Boi; Frank Cobelens; Greg J Fox; Van Luong Dinh; Hoa Binh Nguyen; Guy B Marks; Rein M G J Houben

doi:10.1371/journal.pgph.0005050

Potential impact, costs, and benefits of population-wide screening interventions for tuberculosis in Viet Nam: A mathematical modelling study

PLOS Glob Public Health. 2025 Sep 10;5(9):e0005050. doi: 10.1371/journal.pgph.0005050. eCollection 2025.

Authors

Alvaro Schwalb^{1

2

3}, Katherine C Horton^{1

2}, Jon C Emery^{1

2}, Martin J Harker^{1

2

4}, Lara Goscé^{1

2}, Lara D Veeken⁵, Frances L Garden^{6

7}, Hai Viet Nguyen⁸, Thu-Anh Nguyen^{9

10

11

12}, Khanh Luu Boi¹², Frank Cobelens^{13

14}, Greg J Fox^{10

11

12}, Van Luong Dinh^{15

16}, Hoa Binh Nguyen^{15

16}, Guy B Marks^{6

12

17

18}, Rein M G J Houben^{1

2}

Affiliations

¹ TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.
² Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
³ Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
⁴ Global Health Economics Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁵ Department of Internal Medicine and Radboud Community for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
⁶ South West Sydney Clinical Campuses, University of New South Wales, Sydney, Australia.
⁷ Ingham Institute of Applied Medical Research, Sydney, Australia.
⁸ Ministry of Health, Hanoi, Viet Nam.
⁹ The University of Sydney Vietnam Institute, Ho Chi Minh City, Viet Nam.
¹⁰ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
¹¹ The University of Sydney Institute for Infectious Diseases, Sydney, Australia.
¹² Woolcock Institute of Medical Research, Sydney, Australia.
¹³ Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
¹⁴ Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
¹⁵ National Lung Hospital, National Tuberculosis Control Programme, Hanoi, Viet Nam.
¹⁶ Hanoi Medical University, Hanoi, Viet Nam.
¹⁷ School of Clinical Medicine, University of New South Wales, Sydney, Australia.
¹⁸ Burnet Institute, Melbourne, Australia.

Abstract

Population-wide screening may accelerate the decline of tuberculosis (TB) incidence, but the optimal screening algorithm and duration must weigh resource considerations. We calibrated a deterministic transmission model to TB epidemiology in Viet Nam. We simulated three population-wide screening algorithms from 2025: sputum nucleic acid amplification tests (NAAT, Xpert MTB/RIF Ultra) only; chest radiography (CXR) followed by NAAT; and CXR-only without microbiological confirmation. We determined the annual screening rounds required to reduce pulmonary TB prevalence below 50 per 100,000 people. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs), representing the additional costs (in US$) per disability-adjusted life year (DALY) averted compared to business-as-usual by 2050. Additionally, we evaluated the impact of NAAT cartridges costing US$1 each. NAAT-based algorithms required at least six rounds to reach the prevalence threshold, while CXR-only required three. NAAT-only achieved a prevalence reduction consistent with the ACT3 trial after three rounds. The CXR+NAAT algorithm averted 4.29m DALYs (95%UI:2.86-6.14) at US$225 (95%UI:85-520) per DALY averted compared with business-as-usual. The front-loaded investment of US$161m (95%UI:111-224) annually during the intervention resulted in average annual cost savings of US$12.7m (95%UI:6.7-21.4) up to 2050 compared to the business-as-usual counterfactual. Reducing the cost of NAAT to US$1 led to a 50% and 15% reduction in budget impact and a 63% and 26% reduction in the estimated ICER for the NAAT-only and CXR+NAAT algorithms, respectively. In Viet Nam, population-wide screening could achieve ambitious policy goals. Substantial front-loaded investment is immediately followed by persistent cost savings and could be further offset by more affordable NAATs.

Copyright: © 2025 Schwalb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.