Cost-effectiveness of Latent Tuberculosis Infection Screening before Immigration to Low-Incidence Countries

Prospective migrants to countries where the incidence of tuberculosis (TB) is low (low-incidence countries) receive TB screening; however, screening for latent TB infection (LTBI) before immigration is rare. We evaluated the cost-effectiveness of mandated and sponsored preimmigration LTBI screening...

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Bibliographic Details
Published in:Emerging infectious diseases 2019-04, Vol.25 (4), p.661-671
Main Authors: Campbell, Jonathon R, Johnston, James C, Cook, Victoria J, Sadatsafavi, Mohsen, Elwood, R Kevin, Marra, Fawziah
Format: Article
Language:English
Subjects:
Analysis
Biological response modifiers
Corporate sponsorship
Cost-Benefit Analysis
Cost-effectiveness of Latent Tuberculosis Infection Screening before Immigration to Low-Incidence Countries
cost–effectiveness analysis
cost–utility analysis
Economic aspects
Emigration and Immigration
Health aspects
Humans
Incidence
Interferon
Interferon-gamma Release Tests
Latent Tuberculosis - diagnosis
Latent Tuberculosis - epidemiology
Latent Tuberculosis - microbiology
latent tuberculosis infection
mass screening
Mass Screening - economics
Mass Screening - methods
Quality-Adjusted Life Years
Rifampin
Sensitivity and Specificity
Sustainable development
Transients and Migrants
Tuberculin Test
Tuberculosis
tuberculosis and other mycobacteria
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Summary:Prospective migrants to countries where the incidence of tuberculosis (TB) is low (low-incidence countries) receive TB screening; however, screening for latent TB infection (LTBI) before immigration is rare. We evaluated the cost-effectiveness of mandated and sponsored preimmigration LTBI screening for migrants to low-incidence countries. We used discrete event simulation to model preimmigration LTBI screening coupled with postarrival follow-up and treatment for those who test positive. Preimmigration interferon-gamma release assay screening and postarrival rifampin treatment was preferred in deterministic analysis. We calculated cost per quality-adjusted life-year gained for migrants from countries with different TB incidences. Our analysis provides evidence of the cost-effectiveness of preimmigration LTBI screening for migrants to low-incidence countries. Coupled with research on sustainability, acceptability, and program implementation, these results can inform policy decisions.
ISSN:1080-6040
1080-6059
DOI:10.3201/eid2504.171630