Volume 32, Number 9—September 2026
Research
Posttuberculosis Consequences on Tuberculosis Prevention Effectiveness and Cost-effectiveness among New Immigrants, Canada
Table 1
Key model inputs for immigration TB infection screening and treatment of permanent residents in Canada*
| Parameter | Base-case estimate | PSA distribution (range) |
|---|---|---|
| Health utilities | ||
| Health utility: healthy or TB infection | 0.81 | Beta (0.69–0.91) |
| Annual absolute QALY loss because of TB adverse event† | 0.0077 | PERT (0.000–0.0096) |
| Annual absolute QALY loss associated with TB disease‡ | 0.057 | PERT (0.033–0.100) |
| Annual relative utility decrement because of post-TB illness |
0.018 |
PERT (0.000–0.044)§ |
| Costs, 2023 CAD | ||
| TST screening | $38 | Gamma ($22–$59) |
| Medical evaluation before TPT | $237 | Gamma ($136–$367) |
| Complete TPT, 4R | $515 | Gamma ($163–$1,066) |
| Incomplete TPT, 4R | $234 | Gamma ($21–$687) |
| Contact investigation¶ | $5,429 | Gamma ($3,147–$8,266) |
| Complete TB disease treatment | $21,897 | Gamma ($3,260–$57,909) |
| Incomplete TB disease treatment | $18,495 | Gamma ($13,815–$31,810) |
| TB-related death | $30,562 | Gamma ($8,432–$66,681) |
| Post-TB healthcare, 5 years |
$3,383 |
Gamma ($1,934–$5,231) |
| Model probabilities and transition parameters | ||
| TST sensitivity | 0.78 | Beta (0.74–0.82) |
| TST specificity |
0.94 |
Beta (0.80–1.00) |
| Proportion of population with TB infection | Country- and age-specific# | PERT |
| TB infection screening uptake, status quo | 0.005 | Beta (0.003–0.010) |
| TB infection screening uptake, intervention |
0.68 |
Beta (0.64–0.72) |
| Returning for TST reading | 0.94 | Beta (0.90–0.98) |
| Initiating TPT | 0.88 | Beta (0.80–0.94) |
| Completing TPT, 4R | 0.73 | Beta (0.65–0.81) |
| Effectiveness of complete TPT | 0.90 | Beta (0.63–1.00) |
| Annual progression from TB infection to active TB per 1,000 person-years | 0.85 | lognormal (0.75–1.0) |
| Serious adverse event with TPT, 4R, <50 y | 0.0068 | PERT (0.0039–0.0097) |
| Serious adverse event with TPT, 4R, >50 y | 0.013 | PERT (0.005–0.021) |
| Death during TPT, 4R | 0.00002 | Beta (0.00000–0.000074) |
| Recurrence after TB treatment, annual probability during first 2 y | 0.015 | Triangular (0.0075–0.025) |
| Death hazard ratio after TB treatment |
1.69 |
PERT (1.50–1.91) |
| TB-related case fatality probability, age group, y | ||
| 0–14 | 0.009 | Fixed |
| 15–24 | 0.004 | Fixed |
| 25–64 | 0.014 | Fixed |
| >65 |
0.056 |
Fixed |
| Proportions of persons who immigrate to Canada** | ||
| Age group, y** | ||
| 0–14 | 0.288 | Fixed |
| 15–34 | 0.385 | Fixed |
| 35–54 | 0.291 | Fixed |
| 55–74 | 0.036 | Fixed |
| >75 | 0.001 | Fixed |
| TB incidence in country of origin, cases/100,000 persons | ||
| 0–9 | 0.151 | Fixed |
| 10–49 | 0.186 | Fixed |
| 50–99 | 0.215 | Fixed |
| 100–199 | 0.241 | Fixed |
| >200 | 0.208 | Fixed |
*4R, 4 mo of rifampin; PERT, project evaluation and review technique; PSA, probabilistic sensitivity analysis; QALY, quality-adjusted life years; TB, tuberculosis; TPT, TB preventive treatment; TST, tuberculin skin test; UR, uncertainty range. †Utility decrement of 0.2 for 2 weeks. ‡Health utility decrement of 0.17 for 4 mo. §From Nicolas Menzies (see Acknowledgments); in the communication the post-TB disability weight used for Canada was 0.018 (0.005–0.044). We further reduced the lower bound of the uncertainty interval from 0.005 to 0 to enable evaluation of no disease occurrence. ¶Cost includes nurse time for a contact investigation involving 4 contacts ($3,630) plus costs of evaluation, diagnosis, and treatment for TB infection and disease among contacts, under the assumption all were evaluated for TB disease and infection with 3% having disease and 33% having infection. #Appendix Table 1, https://wwwnc.cdc.gov/EID/article/32/9/26-0473-App1.pdf. **Numbers might not sum to 1 because of rounding.