Active screening for tuberculosis in high-incidence Inuit communities in Canada: a cost-effectiveness analysis

Uppal, Aashna; Nsengiyumva, Ntwali Placide; Signor, Céline; Louis, Frantz Jean; Rochette, Marie; Snowball, Hilda; Etok, Sandra; Annanack, David; Ikey, Julie; Khan, Faiz Ahmad; Schwartzman, Kevin

doi:10.1503/cmaj.210447

Cited by 6 publications

(10 citation statements)

References 23 publications

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“…Additionally, studies from Italy and Germany involved migrants, while the Belgian study focused on migrants as well as on asylum seekers, people in prison, contacts and other people who did not belong to any specific group [ 21 - 23 ]. Eight of the nine studies demonstrated that screening was cost-effective compared with no screening, the passive screening method or other alternatives [ 15 - 18 , 20 - 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Uppal et al compared no active screening, individual community-wide active screening strategy and community-wide screenings conducted every 2 years [ 20 ]. While both active screening methods were cost-effective, the individual community-wide active screening strategy was the most cost-saving.…”

Section: Resultsmentioning

confidence: 99%

“…All the nine articles included were on active PTB cases in low-incidence countries in high-risk cohorts, such as people in prison, migrants, asylum seekers, youths in juvenile detention centres, nursing homes, people with substance use disorder, contacts of TB cases and isolated communities [15][16][17][18][19][20][21][22][23]. A summary of the articles reviewed is in Table 1.…”

Section: Literature Search Findingsmentioning

confidence: 99%

Section: Literature Search Findingsmentioning

confidence: 99%

“…Eight of the nine studies used chest X-ray (CXR) as the primary screening tool for active PTB [15][16][17][18][19][20][21][22]. Two studies from Canada targeted isolated community members and long-term care entrants [19,20]. Four studies from the United Kingdom (UK) involved foreign-born immigrants, contacts of PTB index cases, people with substance use disorder, people experiencing homelessness, people with lower incomes and PLHIV as a target population [15][16][17][18].…”

Section: Literature Search Findingsmentioning

confidence: 99%

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Cost-effectiveness of active tuberculosis screening among high-risk populations in low tuberculosis incidence countries: a systematic review, 2008 to 2023

Gogichadze,

Sagrera,

Vicente

et al. 2024

Eurosurveillance

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Background In countries with a low TB incidence (≤ 10 cases/100,000 population), active pulmonary tuberculosis (PTB) mostly affects vulnerable populations with limited access to healthcare. Thus, passive case-finding systems may not be successful in detecting and treating cases and preventing further transmission. Active and cost-effective search strategies can overcome this problem. Aim We aimed to review the evidence on the cost-effectiveness (C-E) of active PTB screening programmes among high-risk populations in low TB incidence countries. Methods We performed a systematic literature search covering 2008–2023 on PubMed, Embase, Center for Reviews and Dissemination, including Database of Abstracts of Reviews of Effects (DARE), National Health Services Economic Evaluation Database (NHS EED), Global Index Medicus and Cochrane Central Register of Controlled Trials (CENTRAL). Results We retrieved 6,318 articles and included nine in this review. All included studies had an active case-finding approach and used chest X-ray, tuberculin skin test, interferon-gamma release assay and a symptoms questionnaire for screening. The results indicate that screening immigrants from countries with a TB incidence > 40 cases per 100,000 population and other vulnerable populations as individuals from isolated communities, people experiencing homelessness, those accessing drug treatment services and contacts, is cost-effective in low-incidence countries. Conclusion In low-incidence countries, targeting high-risk groups is C-E. However, due to the data heterogenicity, we were unable to compare C-E. Harmonisation of the methods for C-E analysis is needed and would facilitate comparisons. To outline comprehensive screening and its subsequent C-E analysis, researchers should consider multiple factors influencing screening methods and outcomes.

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