Published in PLOS One on 2026-08-27, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Yaw Adusi-Poku, Jacob Solomon Idan, Aliyu Mohammed, Bernard Wadie Adu, Emmanuel Kweku Nakua, Ellis Owusu-Dabo
Source: PLOS One • DOI 10.1371/journal.pone.0356244
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The financial sustainability of universal molecular testing for tuberculosis (TB) remains a critical challenge in high-burden settings. In Ghana, the national program utilizes GeneXpert MTB/RIF for confirmation, yet the high unit cost necessitates efficient triage tools. This study evaluates the cost-effectiveness of Computer-Aided Detection (CAD) based triage compared to the standard of care in Ghana.
This is a prospective cross-sectional diagnostic accuracy study, with an embedded decision-analytic economic evaluation, using primary data from 701 symptomatic outpatients across 23 facilities in Ghana. The cost-effectiveness analysis compared the vendor-recommended threshold of 51 with locally calibrated CAD scores of 56 (weighted Youden) and 68 (standard Youden). These were evaluated against the current Standard of Care (symptom screening and human-read chest X-ray). Health outcomes were measured in Quality-Adjusted Life Years (QALYs) lost, applying a severe morbidity penalty to missed TB cases (False Negatives) to account for prolonged suffering. The primary outcome was the Incremental Cost-Effectiveness Ratio (ICER). Analysis was conducted with R version 4.3.
The CAD-based triage at the weighted Youden threshold of 56 was identified as the optimal clinical strategy, being both more effective and less expensive than the current Standard of Care (SoC). The total health system pathway cost for the CAD-56 strategy and SoC was US$23,449.01 and US$33,239.09, respectively. Threshold of CAD-56 instead of the SoC saved the health system US$9,790.08 on 701 individuals screened and yielding an incremental health gain of 10.08 Quality-Adjusted Life Years (QALYs).
Implementing locally calibrated CAD4TB version 7 at an optimized threshold of 56 as a gatekeeper for molecular testing would be a dominant economic strategy for TB control in Ghana. The findings provide a preliminary evidence for further assessment with nationwide data before national rollout of AI-based triage.
Introduction
Tuberculosis (TB) remains one of the most significant infectious disease threats globally [1]. Despite substantial progress in treatment success, TB continues to be among the leading causes of mortality in the World Health Organization (WHO) African Region. It accounts for approximately a quarter of the global burden [1]. Ghana is no different with an incidence rate of 126 cases per 100,000 population [1]. The introduction of molecular WHO-recommended rapid diagnostic tests (mWRDs) such as GeneXpert MTB/RIF has revolutionized TB diagnosis with high sensitivity and simultaneous detection of rifampicin resistance [2,3]. However, the high unit cost of implementation serves as a primary barrier to universal molecular testing in resource-constrained settings [2,4]. In Ghana, the implementation cost of a single GeneXpert test is estimated at $43.90 per person screened with cartridges, personnel, and logistics cost inclusive [2]. This high expenditure necessitates a more efficient gatekeeping strategy to ensure that expensive molecular diagnostic resources are prioritized for those with the highest probability of disease [5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Yaw Adusi-Poku, Jacob Solomon Idan, Aliyu Mohammed, Bernard Wadie Adu, Emmanuel Kweku Nakua, Ellis Owusu-Dabo. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Annual trends in Mycobacterium tuberculosis detection and rifampicin resistance at a regional referral hospital in Northern Ghana, 2019–2024
- Evidence brief: Cervical leukoplakia in Ghana: Unveiling diagnostic challenges and informing low-resource screening strategies
- Evidence brief: Cost-effectiveness of bubble continuous positive airway pressure in treating severe pneumonia and hypoxaemia in under-five children in Ethiopia
![Study flowchart showing screening techniques and primary screening outcome.A total of 13,861 women were screened. Of these, 12,847 underwent visual inspection (VIA or enhanced visual assessment [EVA]/mobile colposcopy) with leukoplakia assessment, while 1,014 were screened using non-visual methods (HPV DNA testing and/or cytology) without leukoplakia assessment. Overall leukoplakia prevalence was 0.9% (n = 120/13,861; 95% CI: 0.7–1.1). Prevalence was 0.2% (n = 23) among VIA-screened women and 3.7% (n = 97) among EVA-screened women.](https://healthsignalafrica.com/wp-content/uploads/2026/10/hs-pmc13557359-figure-1024x576.jpg)
