Jad Shedrawy1, Charlotte Deogan2,3, Joanna Nederby Öhd2,4, Maria-Pia Hergens2,4, Judith Bruchfeld5,6, Jerker Jonsson3, Andrew Siroka7, Knut Lönnroth2. 1. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. jad.shedrawy@ki.se. 2. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. 3. The Public Health Agency of Sweden, Stockholm, Sweden. 4. Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden. 5. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. 6. Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 7. World Health Organization, Geneva, Switzerland.
Abstract
INTRODUCTION: The majority of tuberculosis (TB) cases in Sweden occur among migrants from endemic countries through activation of latent tuberculosis infection (LTBI). Sweden has LTBI-screening policies for migrants that have not been previously evaluated. This study aimed to assess the cost-effectiveness of the current screening strategy in Stockholm. METHODS: A Markov model was developed to predict the costs and effects of the current LTBI-screening program compared to a scenario of no LTBI screening over a 50-year time horizon. Epidemiological and cost data were obtained from local sources when available. The primary outcomes were incremental cost-effectiveness ratio (ICER) in terms of societal cost per quality-adjusted life year (QALY). RESULTS: Screening migrants in the age group 13-19 years had the lowest ICER, 300,082 Swedish Kronor (SEK)/QALY, which is considered cost-effective in Sweden. In the age group 20-34, ICER was 714,527 SEK/QALY (moderately cost-effectives) and in all age groups above 34 ICERs were above 1,000,000 SEK/QALY (not cost-effective). ICER decreased with increasing TB incidence in country of origin. CONCLUSION: Screening is cost-effective for young cohorts, mainly between 13 and 19, while cost-effectiveness in age group 20-34 years could be enhanced by focusing on migrants from highest incidence countries and/or by increasing the LTBI treatment initiation rate. Screening is not cost-effective in older cohorts regardless of the country of origin.
INTRODUCTION: The majority of tuberculosis (TB) cases in Sweden occur among migrants from endemic countries through activation of latent tuberculosis infection (LTBI). Sweden has LTBI-screening policies for migrants that have not been previously evaluated. This study aimed to assess the cost-effectiveness of the current screening strategy in Stockholm. METHODS: A Markov model was developed to predict the costs and effects of the current LTBI-screening program compared to a scenario of no LTBI screening over a 50-year time horizon. Epidemiological and cost data were obtained from local sources when available. The primary outcomes were incremental cost-effectiveness ratio (ICER) in terms of societal cost per quality-adjusted life year (QALY). RESULTS: Screening migrants in the age group 13-19 years had the lowest ICER, 300,082 Swedish Kronor (SEK)/QALY, which is considered cost-effective in Sweden. In the age group 20-34, ICER was 714,527 SEK/QALY (moderately cost-effectives) and in all age groups above 34 ICERs were above 1,000,000 SEK/QALY (not cost-effective). ICER decreased with increasing TB incidence in country of origin. CONCLUSION: Screening is cost-effective for young cohorts, mainly between 13 and 19, while cost-effectiveness in age group 20-34 years could be enhanced by focusing on migrants from highest incidence countries and/or by increasing the LTBI treatment initiation rate. Screening is not cost-effective in older cohorts regardless of the country of origin.
Authors: James M Trauer; Nompilo Moyo; Ee-Laine Tay; Katie Dale; Romain Ragonnet; Emma S McBryde; Justin T Denholm Journal: Chest Date: 2016-02 Impact factor: 9.410
Authors: Nicholas D Walter; John Painter; Matthew Parker; Phillip Lowenthal; Jennifer Flood; Yunxin Fu; Redentor Asis; Randall Reves Journal: Am J Respir Crit Care Med Date: 2014-01-01 Impact factor: 21.405
Authors: Manish Pareek; John P Watson; L Peter Ormerod; Onn Min Kon; Gerrit Woltmann; Peter J White; Ibrahim Abubakar; Ajit Lalvani Journal: Lancet Infect Dis Date: 2011-04-20 Impact factor: 25.071
Authors: A Wikell; J Jonsson; R Dyrdak; A J Henningsson; A Eringfält; T Kjerstadius; E Hålldin; H Baqir; V Kholod; E Sturegård; J Bruchfeld; T Schön Journal: J Clin Microbiol Date: 2021-09-22 Impact factor: 5.948