Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region

Jad Shedrawy (), Charlotte Deogan, Joanna Nederby Öhd, Maria-Pia Hergens, Judith Bruchfeld, Jerker Jonsson, Andrew Siroka and Knut Lönnroth
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Jad Shedrawy: Karolinska Institutet
Charlotte Deogan: Karolinska Institutet
Joanna Nederby Öhd: Karolinska Institutet
Maria-Pia Hergens: Karolinska Institutet
Judith Bruchfeld: Karolinska University Hospital
Jerker Jonsson: The Public Health Agency of Sweden
Andrew Siroka: World Health Organization
Knut Lönnroth: Karolinska Institutet

The European Journal of Health Economics, 2021, vol. 22, issue 3, No 8, 445-454

Abstract: 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.

Keywords: Latent tuberculosis; Cost-effectiveness; Screening; Migrants (search for similar items in EconPapers)
JEL-codes: I10 I14 (search for similar items in EconPapers)
Date: 2021
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DOI: 10.1007/s10198-021-01265-5

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