A Systematic Review of Studies Evaluating the Cost Utility of Screening High-Risk Populations for Latent Tuberculosis Infection

Campbell, Jonathon R.; Sasitharan, Thenuga; Marra, Fawziah

doi:10.1007/s40258-015-0183-4

Cited by 25 publications

(21 citation statements)

References 37 publications

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“…Hill et al modelled the effect of different TB control interventions on TB incidence in the USA projecting over the next 50 years and concluded that "targeted testing and treatment of LTBI will be necessary (…) to achieve levels close to elimination in an acceptable timeframe" (66) (75). The key finding of the cost-effectiveness of TSTbased migrant screening has been corroborated elsewhere (76). This has to be balanced against potential overdiagnosis/overtreatment (due to the reduced specificity) and feasibility in programmatic screening and the practicalities including the need to return for reading.…”

Section: Impact On Host Country Epidemiologymentioning

confidence: 98%

Effectiveness and cost-effectiveness of screening migrants for active tuberculosis and latent tuberculous infection

Zenner

Hafezi

Potter

et al. 2017

int j tuberc lung dis

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With the advent of the World Health Organization End TB strategy, there has been renewed interest in screening for active tuberculosis (TB), and particularly latent tuberculous infection (LTBI). In low-incidence countries, a high proportion of TB cases are notified among migrants, which often occurs due to LTBI reactivation. We aimed to review the effectiveness and cost-effectiveness of screening migrants for active TB LTBI to inform and support the TB elimination strategy in low-incidence countries. We carried out a narrative review of English language articles published between 1 January 2000 and 31 June 2016 using the PubMed database. All studies that described the effectiveness or cost-effectiveness of active TB or LTBI screening among migrants were included. We identified 55 studies, and included 40 for the effectiveness of screening, 11 for cost-effectiveness and 4 that reported both. Screening for active TB can be effective and cost-effective depending on the setting, target group and screening approach. Pre-entry screening programmes have some impact on the epidemiology of the receiving countries. The effectiveness and cost-effectiveness of LTBI screening as predicted in mathematical models is also highly setting-specific, with best potential results achieved if screening is restricted to high-risk groups and/or to migrants from high-burden countries.

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Section: Impact On Host Country Epidemiologymentioning

confidence: 98%

Effectiveness and cost-effectiveness of screening migrants for active tuberculosis and latent tuberculous infection

Zenner

Hafezi

Potter

et al. 2017

int j tuberc lung dis

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“…For instance, although TB systematic screening has been studied in aspects of methodology, algorithms and in different high-risk populations, the direct evidence remains weak for the impact of screening on health outcomes and TB transmission when compared with passive case-finding alone [51, 52, 69]. Some new diagnostic tools, like Xpert MTB/RIF, have been evaluated recently in many high-risk groups other than in the elderly [69–71]. The evaluation of cost-effectiveness, feasibility and acceptability under specific circumstances also lacks independent study design in the elderly.…”

Section: Research Gapsmentioning

confidence: 99%

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Chung

Leung

et al. 2017

Infect Dis Poverty

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With the rapid pace of population ageing, tuberculosis (TB) in the elderly increasingly becomes a public health challenge. Despite the increasing burden and high risks for TB in the elderly, targeted strategy has not been well understood and evaluated. We undertook a scoping review to identify current TB strategies, research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets. Databases of Embase, MEDLINE, Global health and EBM reviews were searched for original studies, review articles, and policy papers published in English between January 1990 and December 2015. Articles examining TB strategy, program, guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria. Most of them were qualitative studies, issued in high- and middle-income countries and after 2000. To break the chain of TB transmission and reactivation in the elderly, infection control, interventions of avoiding delay in diagnosis and containment are essential for preventing transmission, especially in elderly institutions and aged immigrants; screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people; optimizing early case-finding with a high index of suspicion, systematic screening for prioritized high-risk groups, initial empirical and adequate follow-up treatment with close monitoring and evaluation, as well as enhanced programmatic management are fundamental pillars for active TB elimination. Evaluation of TB epidemiology, risk factors, impacts and cost-effectiveness of interventions, adopting accurate and rapid diagnostic tools, shorter and less toxic preventive therapy, are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway. The framework and principals identified in this study will help to evaluate and improve current program, develop targeted strategy, as well as raise more discussions on the research priority settings and policy transitions. Given the scarceness of policy and evaluated interventions, as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries, the increasing need of a ready TB program for the elderly warrants further research.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0284-4) contains supplementary material, which is available to authorized users.

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“…Previous economic analyses have been performed to assess the cost-effectiveness of mass post-landing screening of new migrants to low-incidence countries, several of which have been highlighted in systematic reviews [ 58 – 60 ]. In an analysis by Dasgupta et al [ 11 ], post-landing surveillance was evaluated for its ability to prevent TB cases in new immigrants to Montreal.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of post-landing latent tuberculosis infection control strategies in new migrants to Canada

et al. 2017

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BackgroundThe majority of tuberculosis in migrants to Canada occurs due to reactivation of latent TB infection. Risk of tuberculosis in those with latent tuberculosis infection can be significantly reduced with treatment. Presently, only 2.4% of new migrants are flagged for post-landing surveillance, which may include latent tuberculosis infection screening; no other migrants receive routine latent tuberculosis infection screening. To aid in reducing the tuberculosis burden in new migrants to Canada, we determined the cost-effectiveness of using different latent tuberculosis infection interventions in migrants under post-arrival surveillance and in all new migrants.MethodsA discrete event simulation model was developed that focused on a Canadian permanent resident cohort after arrival in Canada, utilizing a ten-year time horizon, healthcare system perspective, and 1.5% discount rate. Latent tuberculosis infection interventions were evaluated in the population under surveillance (N = 6100) and the total cohort (N = 260,600). In all evaluations, six different screening and treatment combinations were compared to the base case of tuberculin skin test screening followed by isoniazid treatment only in the population under surveillance. Quality adjusted life years, incident tuberculosis cases, and costs were recorded for each intervention and incremental cost-effectiveness ratios were calculated in relation to the base case.ResultsIn the population under surveillance (N = 6100), using an interferon-gamma release assay followed by rifampin was dominant compared to the base case, preventing 4.90 cases of tuberculosis, a 4.9% reduction, adding 4.0 quality adjusted life years, and saving $353,013 over the ensuing ten-years. Latent tuberculosis infection screening in the total population (N = 260,600) was not cost-effective when compared to the base case, however could potentially prevent 21.8% of incident tuberculosis cases.ConclusionsScreening new migrants under surveillance with an interferon-gamma release assay and treating with rifampin is cost saving, but will not significantly impact TB incidence. Universal latent tuberculosis infection screening and treatment is cost-prohibitive. Research into using risk factors to target screening post-landing may provide alternate solutions.

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A Systematic Review of Studies Evaluating the Cost Utility of Screening High-Risk Populations for Latent Tuberculosis Infection

Cited by 25 publications

References 37 publications

Effectiveness and cost-effectiveness of screening migrants for active tuberculosis and latent tuberculous infection

Effectiveness and cost-effectiveness of screening migrants for active tuberculosis and latent tuberculous infection

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Cost-effectiveness of post-landing latent tuberculosis infection control strategies in new migrants to Canada

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