Presentation (CTI)

OBJECTIVES: WHO recommends digital chest X-ray in combination with computer-assisted detection (DCXR-CAD) for TB (the world’s leading infectious killer) screening in resource-limited settings. CAD generates a probabilistic score suggesting likelihood of TB and it is particularly helpful in improving diagnostic accuracy and efficiency by triaging individuals for confirmatory testing. CAD-based screening has important economic implications, as it shapes diagnostic pathways, determining who is tested, treated, or missed, and therefore influences both cost and health outcomes. However, evidence for cost-effectiveness and implementation costs remains limited. This study addresses this gap by reviewing and critically appraising the economic evidence for CAD for TB screening.
METHODS: A scoping review was conducted following PRISMA 2020 guidelines. Embase (Ovid), PubMed, Web of Science, Cochrane Library and key TB-related grey literature sources were searched to 19 January 2026. Methodological and reporting quality were assessed using the CHEQUE framework and the AI-CHEERS reporting guideline.
RESULTS: Twenty-one studies were included (11 full economic evaluations, 5 partial, and 5 resource-use studies). Most analyses used short time horizons limited to the diagnostic phase, focused on cost per case detected, and adopted a healthcare system perspective. Full economic evaluations mainly adopted a cost-effectiveness framework. Evidence from partial economic evaluations show that reporting of CAD cost components, as well as threshold and subgroup‑specific resource use, was generally limited.
CONCLUSIONS: CXR‑CAD is likely cost‑effective, but its broader and longer‑term benefits, such as reduced transmission and societal costs, are rarely captured. Evidence on costs saving associated with specific CAD thresholds (i.e. number of confirmatory tests required) and detailed implementation inputs remains scarce, and more robust modelling is needed to reflect CAD as a complex, pathway-based intervention.