Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis

Abstract Background Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Florian M. Marx, Barbara Hauer, Nicolas A. Menzies, Walter Haas, Nita Perumal
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/cfb5718fc974410b906e343e097349e2
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:cfb5718fc974410b906e343e097349e2
record_format	dspace
spelling	oai:doaj.org-article:cfb5718fc974410b906e343e097349e22021-11-28T12:12:53ZTargeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis10.1186/s12889-021-12142-41471-2458https://doaj.org/article/cfb5718fc974410b906e343e097349e22021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12142-4https://doaj.org/toc/1471-2458Abstract Background Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the reactivation of latent TB infection (LTBI). Upon-entry screening for LTBI and TB preventive treatment (TPT) are considered worthwhile if targeted to asylum seekers from high-incidence countries who usually present with higher rates of LTBI. However, there is insufficient knowledge about optimal incidence thresholds above which introduction could be cost-effective. We aimed to estimate, among asylum seekers in Germany, the health impact and costs of upon-entry LTBI screening/TPT introduced at different thresholds of country-of-origin TB incidence. Methods We sampled hypothetical cohorts of 30–45 thousand asylum seekers aged 15 to 34 years expected to arrive in Germany in 2022 from cohorts of first-time applicants observed in 2017–2019. We modelled LTBI prevalence as a function of country-of-origin TB incidence fitted to data from observational studies. We then used a probabilistic decision-analytic model to estimate health-system costs and quality-adjusted life years (QALYs) under interferon gamma release assay (IGRA)-based screening for LTBI and rifampicin-based TPT (daily, 4 months). Incremental cost-effectiveness ratios (ICERs) were calculated for scenarios of introducing LTBI screening/TPT at different incidence thresholds. Results We estimated that among 15- to 34-year-old asylum seekers arriving in Germany in 2022, 17.5% (95% uncertainty interval: 14.2–21.6%) will be latently infected. Introducing LTBI screening/TPT above 250 per 100,000 country-of-origin TB incidence would gain 7.3 (2.7–14.8) QALYs at a cost of €51,000 (€18,000–€114,100) per QALY. Lowering the threshold to ≥200 would cost an incremental €53,300 (€19,100–€122,500) per additional QALY gained relative to the ≥250 threshold scenario; ICERs for the ≥150 and ≥ 100 thresholds were €55,900 (€20,200–€128,200) and €62,000 (€23,200–€142,000), respectively, using the next higher threshold as a reference, and considerably higher at thresholds below 100. Conclusions LTBI screening and TPT among 15- to 34-year-old asylum seekers arriving in Germany could produce health benefits at reasonable additional cost (with respect to international benchmarks) if introduced at incidence thresholds ≥100. Empirical trials are needed to investigate the feasibility and effectiveness of this approach.Florian M. MarxBarbara HauerNicolas A. MenziesWalter HaasNita PerumalBMCarticlePublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-16 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Public aspects of medicine RA1-1270
spellingShingle	Public aspects of medicine RA1-1270 Florian M. Marx Barbara Hauer Nicolas A. Menzies Walter Haas Nita Perumal Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis
description	Abstract Background Enhancing tuberculosis (TB) prevention and care in a post-COVID-19-pandemic phase will be essential to ensure progress towards global TB elimination. In low-burden countries, asylum seekers constitute an important high-risk group. TB frequently arises post-immigration due to the reactivation of latent TB infection (LTBI). Upon-entry screening for LTBI and TB preventive treatment (TPT) are considered worthwhile if targeted to asylum seekers from high-incidence countries who usually present with higher rates of LTBI. However, there is insufficient knowledge about optimal incidence thresholds above which introduction could be cost-effective. We aimed to estimate, among asylum seekers in Germany, the health impact and costs of upon-entry LTBI screening/TPT introduced at different thresholds of country-of-origin TB incidence. Methods We sampled hypothetical cohorts of 30–45 thousand asylum seekers aged 15 to 34 years expected to arrive in Germany in 2022 from cohorts of first-time applicants observed in 2017–2019. We modelled LTBI prevalence as a function of country-of-origin TB incidence fitted to data from observational studies. We then used a probabilistic decision-analytic model to estimate health-system costs and quality-adjusted life years (QALYs) under interferon gamma release assay (IGRA)-based screening for LTBI and rifampicin-based TPT (daily, 4 months). Incremental cost-effectiveness ratios (ICERs) were calculated for scenarios of introducing LTBI screening/TPT at different incidence thresholds. Results We estimated that among 15- to 34-year-old asylum seekers arriving in Germany in 2022, 17.5% (95% uncertainty interval: 14.2–21.6%) will be latently infected. Introducing LTBI screening/TPT above 250 per 100,000 country-of-origin TB incidence would gain 7.3 (2.7–14.8) QALYs at a cost of €51,000 (€18,000–€114,100) per QALY. Lowering the threshold to ≥200 would cost an incremental €53,300 (€19,100–€122,500) per additional QALY gained relative to the ≥250 threshold scenario; ICERs for the ≥150 and ≥ 100 thresholds were €55,900 (€20,200–€128,200) and €62,000 (€23,200–€142,000), respectively, using the next higher threshold as a reference, and considerably higher at thresholds below 100. Conclusions LTBI screening and TPT among 15- to 34-year-old asylum seekers arriving in Germany could produce health benefits at reasonable additional cost (with respect to international benchmarks) if introduced at incidence thresholds ≥100. Empirical trials are needed to investigate the feasibility and effectiveness of this approach.
format	article
author	Florian M. Marx Barbara Hauer Nicolas A. Menzies Walter Haas Nita Perumal
author_facet	Florian M. Marx Barbara Hauer Nicolas A. Menzies Walter Haas Nita Perumal
author_sort	Florian M. Marx
title	Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis
title_short	Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis
title_full	Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis
title_fullStr	Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis
title_full_unstemmed	Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis
title_sort	targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/cfb5718fc974410b906e343e097349e2
work_keys_str_mv	AT florianmmarx targetingscreeningandtreatmentforlatenttuberculosisinfectiontowardsasylumseekersfromhighincidencecountriesamodelbasedcosteffectivenessanalysis AT barbarahauer targetingscreeningandtreatmentforlatenttuberculosisinfectiontowardsasylumseekersfromhighincidencecountriesamodelbasedcosteffectivenessanalysis AT nicolasamenzies targetingscreeningandtreatmentforlatenttuberculosisinfectiontowardsasylumseekersfromhighincidencecountriesamodelbasedcosteffectivenessanalysis AT walterhaas targetingscreeningandtreatmentforlatenttuberculosisinfectiontowardsasylumseekersfromhighincidencecountriesamodelbasedcosteffectivenessanalysis AT nitaperumal targetingscreeningandtreatmentforlatenttuberculosisinfectiontowardsasylumseekersfromhighincidencecountriesamodelbasedcosteffectivenessanalysis
_version_	1718408168182120448

Targeting screening and treatment for latent tuberculosis infection towards asylum seekers from high-incidence countries – a model-based cost-effectiveness analysis

Ejemplares similares