Mobile TB units good value for money, study finds

Mobile TB diagnosis units are a cost effective means to find and treat people with the disease in urban areas, according to research, as NICE urges more targeted action to prevent further spread.

Mobile X-ray units can help in detection of TB (Photograph: SPL)
Mobile X-ray units can help in detection of TB (Photograph: SPL)

A BMJ study found mobile X-ray units to diagnose and treat people with TB are good value for money.

NICE urged greater use of the units to prevent spread among hard-to-reach groups.

There were 9,040 TB cases in the UK in 2009. London, which accounted for 38%, has experienced a large rise in prevalence over the past two decades.

Hard-to-reach groups in London, such as homeless people, problem drug users and prisoners, were about 10-30 times more likely than the general London population to have TB, research has found.

Untreated TB can be fatal and delayed diagnosis and incomplete treatment can lead to it spreading in the community and cause drug resistance.

The study looked at the London-based ‘find and treat’ service, which visits areas where people are at high risk of TB, such as hostels or homeless day centres.

The service voluntarily screens people and, if infected, they are referred to hospital teams for treatment.

Since 2007, the service has identified on average 16 people with TB each year among hard-to-reach populations. It also supports the treatment for a further 100-plus cases.

The study found that it costs around £6,400 to £10,000 for every year of life in good health which it gives the targeted population – well within the criteria that the NHS deems is cost effective.

Co-author Dr Peter White of the Health Protection Agency (HPA) and Imperial College London, said: ‘With TB numbers remaining high in London, the 'find and treat' programme was identified as a potential method of tackling the problem in these high-risk populations.

'It has proved to be successful in identifying and offering treatment to those unaware they were infected with TB.’

Lead author Dr Ibrahim Abubakar of the HPA, said: ‘While this intervention alone will not reverse the rise in TB in London, it is likely to have an effect on the segment of the population with the greatest evidence of ongoing transmission.’

The NICE draft guidance recommends commissioners of TB control measures adopt a ‘more proactive approach’ to detecting TB in harder to reach groups by using mobile X-ray units.

The measures also encourage screening among prisoners and migrants.

Professor Mike Kelly, NICE director of public health, said: ‘Evidence shows relying on these groups to present themselves to health services doesn’t work, and we need to adopt a more proactive approach to identify and treat this disease.’

He added: ‘We actively encourage anyone with an interest in this condition to contribute to our consultation on these draft recommendations.'

The consultations on the draft guidance closes 3 November.

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