Modeling the Cost-Effectiveness of Latent Tuberculosis Screening and Treatment Strategies in Recent Migrants to a Low-Incidence Setting. Issue 2 (21st May 2021)

• Record Type: Journal Article
• Authors: Dale, Katie D; Abayawardana, Milinda J; McBryde, Emma S; Trauer, James M; Carvalho, Natalie
• Is Part Of: American journal of epidemiology. Volume 191:Issue 2(2022)
• Page Start: 255
• Page End: 270
• Publication Date: 2021-05-21
• Subjects: cost-benefit analysis -- emigrants and immigrants -- epidemiology -- latent tuberculosis -- tuberculosis; Epidemiology -- Periodicals; Public health -- Periodicals; 614.4
• DOI: 10.1093/aje/kwab150
• Languages: English
• ISSNs: 0002-9262

Abstract

Abstract: Many tuberculosis (TB) cases in low-incidence settings are attributed to reactivation of latent TB infection (LTBI) acquired overseas. We assessed the cost-effectiveness of community-based LTBI screening and treatment strategies in recent migrants to a low-incidence setting (Australia). A decision-analytical Markov model was developed that cycled 1 migrant cohort (≥11-year-olds) annually over a lifetime from 2020. Postmigration/onshore and offshore (screening during visa application) strategies were compared with existing policy (chest x-ray during visa application). Outcomes included TB cases averted and discounted cost per quality-adjusted life-year (QALY) gained from a health-sector perspective. Most recent migrants are young adults and cost-effectiveness is limited by their relatively low LTBI prevalence, low TB mortality risks, and high emigration probability. Onshore strategies cost at least $203, 188 (Australian) per QALY gained, preventing approximately 2.3%–7.0% of TB cases in the cohort. Offshore strategies (screening costs incurred by migrants) cost at least $13, 907 per QALY gained, preventing 5.5%–16.9% of cases. Findings were most sensitive to the LTBI treatment quality-of-life decrement (further to severe adverse events); with a minimal decrement, all strategies caused more ill health than they prevented. Additional LTBI strategies in recent migrants could only marginally contribute to TB elimination and are unlikely to be cost-effective unless screening costs are borne by migrants and potential LTBI treatment quality-of-life decrements are ignored.