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Peer-reviewedCC BY 4.0PLOS Global Public Health

Resources to implement general population mobile chest x-ray screening for tuberculosis in Uganda: A trial-based costing analysis

  • Tyler Scott Johnson1
  • David Isooba2
  • Susan Birabwa3
  • Juliet Kakeeto4
  • Kenneth Ndyabayunga5
  • Deborah Nantale
  • Ivan Mugabi
  • Violet Nakiiza
  • Annet Nalutaaya
  • Peter James Kitonsa
  • Emily A. Kendall
  • Achilles Katamba
1 more authors
  • David W. Dowdy
5 affiliations
  1. 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
  2. 2Uganda TB Implementation Research Consortium, Walimu, Kampala, Uganda
  3. 3Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
  4. 4Clinical Epidemiology and Biostatics Unit, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
  5. 5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Abstract

Mobile chest X-ray (CXR) screening interventions are recommended for tuberculosis (TB) screening in high-burden settings, but implementation costs are variable and underreported. Using time-driven activity-based costing, we evaluated the costs of implementing general-population mobile CXR screening in peri-urban Uganda. We conducted a micro-costing analysis of mobile CXR screening using data from an ongoing randomized crossover trial. We adopted a healthcare payer perspective, categorizing costs into equipment, personnel, space, implementation, and consumables. We calculated per-participant costs for each step in the TB screening cascade, as well as total screening and diagnostic costs per positive microbiological result (Xpert Ultra). Sensitivity analyses evaluated the cost implications of varying the screening volume or radiographic risk score thresholds. Among 90,668 age-eligible participants completing CXR screening, 14,630 sputum specimens were collected for Xpert testing (16.1%), including 1,676 from participants who submitted sputum without completing CXR. Overall, 511 participants had valid Xpert-positive results (3.5%), corresponding to 5.6 Xpert-positive results per 1,000 CXRs performed. The estimated cost was $4.41 per person screened and $1,299 per Xpert-positive result (95% uncertainty interval: 1,134−1,488). Screening and diagnostic costs accounted for 64% and 36% of the cost per Xpert-positive result, respectively. Daily screening volume strongly influenced the cost per positive Xpert result, whereas less stringent X-ray thresholds increased the number of TB cases detected with minimal impact on average cost per positive Xpert. Mobile CXR screening interventions for TB require substantial investment in resources. Program planners can optimize efficiency by targeting high-burden populations, increasing participant volume, and optimizing X-ray risk cutoffs for follow-up diagnostic testing. Our findings highlight the value of context-specific cost data for guiding decisions on scaling up TB screening interventions.

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Cite

BibTeXRIS
BibTeX
@article{johnson2026resources,
  title = {{Resources to implement general population mobile chest x-ray screening for tuberculosis in Uganda: A trial-based costing analysis}},
  author = {Tyler Scott Johnson and David Isooba and Susan Birabwa and Juliet Kakeeto and Kenneth Ndyabayunga and Deborah Nantale and Ivan Mugabi and Violet Nakiiza and Annet Nalutaaya and Peter James Kitonsa and Emily A. Kendall and Achilles Katamba and David W. Dowdy},
  journal = {PLOS Global Public Health},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pgph.0005950},
  url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005950},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Resources to implement general population mobile chest x-ray screening for tuberculosis in Uganda: A trial-based costing analysis
AU  - Tyler Scott Johnson
AU  - David Isooba
AU  - Susan Birabwa
AU  - Juliet Kakeeto
AU  - Kenneth Ndyabayunga
AU  - Deborah Nantale
AU  - Ivan Mugabi
AU  - Violet Nakiiza
AU  - Annet Nalutaaya
AU  - Peter James Kitonsa
AU  - Emily A. Kendall
AU  - Achilles Katamba
AU  - David W. Dowdy
PY  - 2026
DA  - 2026/09/10
JO  - PLOS Global Public Health
DO  - 10.1371/journal.pgph.0005950
UR  - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005950
AB  - Mobile chest X-ray (CXR) screening interventions are recommended for tuberculosis (TB) screening in high-burden settings, but implementation costs are variable and underreported. Using time-driven activity-based costing, we evaluated the costs of implementing general-population mobile CXR screening in peri-urban Uganda. We conducted a micro-costing analysis of mobile CXR screening using data from an ongoing randomized crossover trial. We adopted a healthcare payer perspective, categorizing costs into equipment, personnel, space, implementation, and consumables. We calculated per-participant costs for each step in the TB screening cascade, as well as total screening and diagnostic costs per positive microbiological result (Xpert Ultra). Sensitivity analyses evaluated the cost implications of varying the screening volume or radiographic risk score thresholds. Among 90,668 age-eligible participants completing CXR screening, 14,630 sputum specimens were collected for Xpert testing (16.1%), including 1,676 from participants who submitted sputum without completing CXR. Overall, 511 participants had valid Xpert-positive results (3.5%), corresponding to 5.6 Xpert-positive results per 1,000 CXRs performed. The estimated cost was $4.41 per person screened and $1,299 per Xpert-positive result (95% uncertainty interval: 1,134−1,488). Screening and diagnostic costs accounted for 64% and 36% of the cost per Xpert-positive result, respectively. Daily screening volume strongly influenced the cost per positive Xpert result, whereas less stringent X-ray thresholds increased the number of TB cases detected with minimal impact on average cost per positive Xpert. Mobile CXR screening interventions for TB require substantial investment in resources. Program planners can optimize efficiency by targeting high-burden populations, increasing participant volume, and optimizing X-ray risk cutoffs for follow-up diagnostic testing. Our findings highlight the value of context-specific cost data for guiding decisions on scaling up TB screening interventions.
SN  - 2767-3375
ER  -