Background
This
study explored the effect of screening and treatment of refugees for latent
tuberculosis infection (LTBI) before entrance to the United States as a
strategy for reducing active tuberculosis (TB). The purpose of this study was
to estimate the costs and benefits of LTBI screening and treatment in United
States bound refugees prior to arrival.
Methods
Costs
were included for foreign and domestic LTBI screening and treatment and the
domestic treatment of active TB. A decision tree with multiple Markov nodes was
developed to determine the total costs and number of active TB cases that
occurred in refugee populations that tested 55, 35, and 20 % tuberculin
skin test positive under two models: no overseas LTBI screening and overseas
LTBI screening and treatment. For this analysis, refugees that tested 55, 35,
and 20 % tuberculin skin test positive were divided into high, moderate, and
low LTBI prevalence categories to denote their prevalence of LTBI relative to
other refugee populations.
Results
For
a hypothetical 1-year cohort of 100,000 refugees arriving in the United States
from regions with high, moderate, and low LTBI prevalence, implementation of
overseas screening would be expected to prevent 440, 220, and 57 active TB
cases in the United States during the first 20 years after arrival. The
cost savings associated with treatment of these averted cases would offset the
cost of LTBI screening and treatment for refugees from countries with high (net
cost-saving: $4.9 million) and moderate (net cost-saving: $1.6 million) LTBI
prevalence. For low LTBI prevalence populations, LTBI screening and treatment
exceed expected future TB treatment cost savings (net cost of $780,000).
Conclusions
Implementing
LTBI screening and treatment for United States bound refugees from countries
with high or moderate LTBI prevalence would potentially save millions of
dollars and contribute to United States TB elimination goals. These estimates
are conservative since secondary transmission from tuberculosis cases in the
United States was not considered in the model.
Below: Proportion of Refugees with
LTBI Completing Treatment with 12 Weekly Doses of Isoniazid and Rifapentine.
LTBI = latent tuberculosis
infection; TST = tuberculin
skin test; With no overseas screening, all screening and treatment for LTBI
takes place in the United States. With overseas screening, initial screening
takes place overseas and TST positive refugees are offered treatment overseas.
Below: Total Cost Incurred with Two Programs for Identifying and
Treating LTBI in 100,000 U.S. -Bound Refugees. LTBI = latent tuberculosis
infection; TST = tuberculin skin test; U.S. = United States. With no overseas
screening, all screening and treatment for LTBI takes place in the U.S. With
overseas screening, initial screening takes place overseas and TST positive
refugees are offered treatment overseas. Costs incurred overseas include the
TST, 12 weeks of once-weekly rifapentine and isoniazid, and labor to
administer the medications. Costs incurred domestically include the TST,
12 weeks of once-weekly rifapentine and isoniazid, labor to administer the
medications, and treatment of active TB patients
Full article at: http://goo.gl/XxFOj2
By:
Division of Global Migration and Quarantine, Centers for Disease
Control and Prevention, Atlanta, GA, USA
More at: https://twitter.com/hiv_insight
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