Cost-effectiveness analysis of adding tuberculosis household contact investigation on passive case-finding strategy in Southwestern Uganda

Dickens Odongo; Bernard Omech; Alfred Acanga

doi:10.1371/journal.pone.0288761

Peer Review History

Original SubmissionFebruary 22, 2023
11 May 2023 Decision Letter - Hamufare Dumisani Dumisani Mugauri, Editor PONE-D-23-05092Cost-Effectiveness Analysis of Adding Tuberculosis Household Contact Investigation on Passive Case-Finding Strategy in Southwestern Uganda.PLOS ONE Dear Dr. Odongo, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 25 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Manuscript does not meet style/formatting guidelines of the journal. Pages are landscape and do not contain line numbers. “It entails screening for Tuberculosis infection, with or without latent TB infection” confusing wording. I believe the guidelines say that contacts do not need confirmation of a TB infection to receive TPT. The analysis of is well described and clearly presented. However, the finding needs to be more nuanced. The authors note that reductions in TB transmission (and thus future TB burden) are not accounted for in their costing analysis; these are tangible benefits which are being disregarded. This results in underestimation of effectiveness, which is acknowledged as a limitation. At the same time, the negative consequences for low TB case detection in the PCF arm are not factored into the analysis. People with TB who are not treated, or only treated after a long delay, contribute to sustained burden, morbidity and mortality. Ignoring these consequences in the PCF costs again under estimates the cost effectiveness of HCI. This is not acknowledged anywhere in the manuscript. Thus, it feels very difficult for the review to accept “adding [HCI] to the [PCF] in the Southwestern Uganda Tuberculosis control program was not cost-effective”. In addition, the discussion makes no comment on the lack of TPT provision, which should have major implications for TB burden (cases averted) and HIV epidemic control in the medium and long term. Costs for TPT provision can be subsidized through HCI. They also do not comment on the entry point for contact investigation – TB symptoms – which could result in about 40% of people with infectious pulmonary TB being missed (according to Uganda prevalence survey findings). Given that HCI is one of the most basic package of services in TB care, I recommend the authors word their findings more carefully. Something like, this specific implementation of PCF+HCI proved to be not cost-effective, rather than HCI as a strategy. There is some context for the analysis’s limitations in the discussion, but strongly worded sentences are included elsewhere which can overstate the findings. Reviewer #2: While the abstract is clearly presented by the authors, they miss out on key pieces of information required for a cost effectiveness study. For example in the abstract there is no clear mention if any discounting rates were applied in this study, to allow readers to understand the implications of such decisions in the analysis. it was also critical for the authors to clearly state how the sensitivity analysis was used to address uncertainty. The methods and results sections are comprehensive and the authors should be applauded for sharing the key ingredients of data that went into this analysis. However, it is critical for the authors to mention if this was a synthesis based evaluation of already existing data and to which extent this data was used. This can be mentioned in the abstract ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Howard Nyika ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. 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Revision 1
29 Jun 2023 Author Response A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. We have taken care of this throughout the manuscript. 2. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. We have made changes to the cover letter, repository information of my data can obtain after seeking a written permission from the Assistance Commissioner of the Uganda National Tuberculosis and Leprosy program, Kampala Uganda. Reviewers' comments: Reviewer's Responses to Questions and Responses from the Author Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ________________________________________ 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g., participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ________________________________________ 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Manuscript does not meet style/formatting guidelines of the journal. Pages are landscape and do not contain line numbers. We have corrected the style/formatting guidelines of the manuscript; pages are in portrait and has line numbers. “It entails screening for Tuberculosis infection, with or without latent TB infection” confusing wording. I believe the guidelines say that contacts do not need confirmation of a TB infection to receive TPT. It entails screening for Tuberculosis disease, with or without latent TB infection.” corrected. The analysis of is well described and clearly presented. However, the finding needs to be more nuanced. The authors note that reductions in TB transmission (and thus future TB burden) are not accounted for in their costing analysis; these are tangible benefits which are being disregarded. This results in underestimation of effectiveness, which is acknowledged as a limitation. At the same time, the negative consequences for low TB case detection in the PCF arm are not factored into the analysis. People with TB who are not treated, or only treated after a long delay, contribute to sustained burden, morbidity, and mortality. Ignoring these consequences in the PCF costs again underestimates the cost effectiveness of HCI. This is not acknowledged anywhere in the manuscript. Thus, it feels very difficult for the review to accept “adding [HCI] to the [PCF] in the Southwestern Uganda Tuberculosis control program was not cost-effective”. We have included the comments in the discussion section (page 22) and acknowledge them in the limitation. We did not factor some of the long-term effects of HCI (Death Averted, Life saved, reduction of burden of TB, transmission) because of short analytical time horizon of this study. in addition, the discussion makes no comment on the lack of TPT provision, which should have major implications for TB burden (cases averted) and HIV epidemic control in the medium and long term. Costs for TPT provision can be subsidized through HCI. They also do not comment on the entry point for contact investigation – TB symptoms – which could result in about 40% of people with infectious pulmonary TB being missed (according to Uganda prevalence survey findings). We appreciated these comments and has been included in our manuscript, Discussion section page 22. Given that HCI is one of the most basic packages of services in TB care, I recommend the authors word their findings more carefully. Something like, this specific implementation of PCF+HCI proved to be not cost-effective, rather than HCI as a strategy. We have taken this recommendation seriously and included in the Conclusion section of the manuscript and abstract. There is some context for the analysis’s limitations in the discussion, but strongly worded sentences are included elsewhere which can overstate the findings. Reviewer #2: While the abstract is clearly presented by the authors, they miss out on key pieces of information required for a cost effectiveness study. For example, in the abstract there is no clear mention if any discounting rates were applied in this study, to allow readers to understand the implications of such decisions in the analysis. We did not apply a discount rate because of the short analytic time horizon. This was mentioned in the abstract page 2 and methodology section page 7 of the manuscript. it was also critical for the authors to clearly state how the sensitivity analysis was used to address uncertainty. It was stated in the result section of page 12 and Discussion section of page 21 of the manuscript. The methods and results sections are comprehensive, and the authors should be applauded for sharing the key ingredients of data that went into this analysis. However, it is critical for the authors to mention if this was a synthesis-based evaluation of already existing data and to which extent this data was used. This can be mentioned in the abstract. It was a synthesis-based evaluation of already existing data and data was extracted from the national system, as well as from the available primary tools at the facility. We mentioned it in the abstract and methodology section. Attachments Attachment Submitted filename: Response to Reviewers.pdf https://doi.org/10.1371/journal.pone.0288761.r002
5 Jul 2023 Decision Letter - Hamufare Dumisani Dumisani Mugauri, Editor Cost-Effectiveness Analysis of Adding Tuberculosis Household Contact Investigation on Passive Case-Finding Strategy in Southwestern Uganda. PONE-D-23-05092R1 Dear Dr. Odongo, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Hamufare Dumisani Dumisani Mugauri, Ph.D. Public Health Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0288761.r003
Formally Accepted
10 Jul 2023 Acceptance Letter - Hamufare Dumisani Dumisani Mugauri, Editor PONE-D-23-05092R1 Cost-Effectiveness Analysis of Adding Tuberculosis Household Contact Investigation on Passive Case-Finding Strategy in Southwestern Uganda Dear Dr. Odongo: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Mr Hamufare Dumisani Dumisani Mugauri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0288761.r004

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