A screening strategy for latent tuberculosis in healthcare workers: Cost-effectiveness and budget impact of universal versus targeted screening

Abstract

Objective:To evaluate the clinical, cost-efficiency, and budgetary implications of universal versus targeted latent tuberculosis infection (LTBI) screening strategies among healthcare workers (HCWs) in an intermediate tuberculosis (TB)-burden country.Design:Pragmatic cost-effectiveness and budget impact analysis using decision-analytic modeling.Setting:A tertiary-care hospital in Singapore.Methods:We compared 7 potentially implementable LTBI screening programs including universal and targeted strategies with different screening frequencies. Feasible targeting methods included stratification by country of origin (a proxy for risk of prior TB exposure) and by high-risk occupation. The clinical and financial consequences of each strategy were estimated relative to “no screening” (current practice) and compared to locally appropriate cost-effectiveness thresholds. All analyses were conducted from the hospital’s perspective over a 3-year time horizon, based on the typical hospital planning period. Parameter uncertainties were accounted for using sensitivity analyses.Results:In our model, relative to current practice, screening new international hires and triennial screening of existing high-risk workers is most cost-effective (US$58 per quality adjusted life year [QALY]) and decreases active TB cases from 19 to 14. Screening all new hires combined with triennial universal screening, with or without annual high-risk screening or annual universal screening, reduced active TB to a range of 19 to 6 cases, but these strategies are less cost-effective and require substantially higher expenditures.Conclusions:Targeted LTBI screening for HCWs can be highly cost-effective for hospitals in settings similar to Singapore. More inclusive screening strategies (including regular universal screening) can yield better outcomes but are less efficient and may even be unaffordable.

Evaluation and treatment of latent tuberculosis infection among healthcare workers in Korea: A multicentre cohort analysis

“…The completion rate of LTBI in this study was 73.3% which is comparable to previous reports [17, 20]. The absence of difference in characteristics between subjects who completed treatment and those who did not was surprising.…”

“…Besides, HCWs may transmit infection to patients in health care settings. Therefore, regular screening for TB and LTBI among HCWs has been previously conducted in low incidence settings [14, 15], although there were several controversial issues including cost-effectiveness [16, 17]. Furthermore, the diagnosis and treatment of LTBI among HCWs in settings of intermediate burden such as South Korea may help with the control of TB in health care settings.…”

Occupational Screening for Latent Tuberculosis Infection

“…3 That report identified 2 economic evaluations and 3 evidence-based guidelines. 3 The purpose of the current report is to summarize and critically appraise the economic evaluations identified previously [4][5][6] to assess the cost-effectiveness of occupational screening for LTBI infection.…”

“…In the previous CADTH report, 8 a total of 462 citations were identified in the literature search and 5 potentially relevant publications were retrieved from the grey literature. Fourteen potentially relevant reports were identified and retrieved for full-text review, of which 2 economic evaluations 4,5 met the inclusion criteria and were included in this report.…”

Innovative Strategies for Developing Tuberculosis Implementation Research in Sudan

“…Many of these factors in uence health seeking behaviour and perceptions about the disease, as well as case-de nition and the epidemiology of tuberculosis, and, in general, methods, points and approaches for potential intervention. Moreover, the symptomatic cases are not adequately reported, so data on the actual burden of the disease is crucial for the public health authorities to design control programs (15)(16)(17). The prevalence of risk factors of tuberculosis can be used to ascertain the vulnerable groups and develop public health strategies namely adequate surveillance system and early warning and response body to guard particularly against multi-drug resistant tuberculosis.…”