Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 25, Number 4—April 2019
Research

Cost-effectiveness of Latent Tuberculosis Infection Screening before Immigration to Low-Incidence Countries

Jonathon R. Campbell, James C. Johnston, Victoria J. Cook, Mohsen Sadatsafavi, R. Kevin Elwood, and Fawziah MarraComments to Author 
Author affiliations: University of British Columbia, Vancouver, British Columbia, Canada (J.R. Campbell, J.C. Johnston, V.J. Cook, M. Sadatsafavi, R.K. Elwood, F. Marra); British Columbia Centre for Disease Control, Vancouver (J.C. Johnston, V.J. Cook, R.K. Elwood)

Main Article

Table 4

Results in various TB incidence settings of implementing intervention strategies for screening and treatment of latent TB infection in immigrants*

Intervention % Identified for post-arrival followup Cost/1,000 persons, $ No. QALYs/1,000 persons No. TB cases/1,000 persons % Reduction in TB incidence Cost per QALY gained, $†
Low TB incidence countries
Base case 0.82 9,681 13,761.03 0.41 NC NC
SEQ/RIF 4.02 60,996 13,761.30 0.26 36.87 191,889
SEQ/INH 4.02 67,309 13,761.08 0.28 32.00 1,289,335‡
IGRA/RIF 6.43 80,107 13,761.22 0.22 46.16 373,773‡
IGRA/INH 6.43 91,056 13,761.07 0.25 39.07 2,315,425‡
TST/RIF 22.99 120,910 13,760.65 0.24 40.08 Dominated
TST/INH
22.99
 162,233
 13,760.59
 0.27
 34.12
 Dominated
Moderate TB incidence countries
Base case 2.88 58,301 13,735.03 2.47 NC NC
SEQ/RIF 11.99 121,950 13,736.36 1.57 36.52 47,561
IGRA/RIF 14.52 129,036 13,736.66 1.33 46.36 43,343
SEQ/INH 11.99 142,739 13,735.71 1.72 30.55 122,821‡
IGRA/INH 14.52 154,804 13,736.69 1.50 39.47 58,154‡
TST/RIF 38.96 206,145 13,736.84 1.46 40.77 81,548‡
TST/INH
38.96
 277,998
 13,735.98
 1.61
 34.88
 230,641‡
High TB incidence countries
Base case 2.79 122,928 13,702.56 5.39 NC NC
SEQ/RIF 19.13 194,289 13,704.93 3.44 36.06 29,997
IGRA/RIF 23.60 199,878 13,705.48 2.91 45.99 26,350
SEQ/INH 19.13 231,835 13,704.38 3.73 30.73 59,655‡
TST/RIF 44.24 247,488 13,704.35 3.28 39.21 69,421‡
IGRA/INH 23.60 263,572 13,704.93 3.22 40.18 59,154‡
TST/INH
44.24
 348,686
 13,704.15
 3.54
 34.36
 141,336‡
Very high TB incidence countries
Base case 3.87 184,357 13,666.32 8.12 NC NC
SEQ/RIF 27.45 263,628 13,670.25 5.18 36.23 20,165
IGRA/RIF 33.86 268,840 13,671.50 4.41 45.61 16,291
TST/RIF 49.82 318,025 13,670.32 5.62 30.76 33,403‡
SEQ/INH 27.45 318,435 13,671.23 4.86 40.16 27,296‡
IGRA/INH 33.86 337,716 13,671.02 4.97 38.82 32,657‡
TST/INH 49.82 415,877 13,669.91 5.33 34.34 64,494‡

*Very high incidence, >200 cases per 100,000; high incidence: >100 and <200 cases/100,000; moderate incidence, >30 and <100 cases/100,000; low incidence: <30 cases/100,000. IGRA, interferon-gamma release assay; INH, isoniazid; NC, not calculable; QALY, quality-adjusted life year; RIF, rifampin; SEQ, sequential screening; TB, tuberculosis; TST, tuberculin skin test.
†*The cost per QALY gained is calculated in comparison to the base case. Dominated indicates that an intervention strategy has higher costs and worse outcomes compared to the base case. Costs are in CAD.
‡This intervention strategy is strictly dominated by another intervention strategy. It is more expensive and has worse outcomes.

Main Article

Page created: March 17, 2019
Page updated: March 17, 2019
Page reviewed: March 17, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external