Should NICE reconsider the 2016 UK guidelines on TB contact tracing? A cost-effectiveness analysis of contact investigations in London

Abstract

(245) 17Background -In January 2016, clinical TB guidance in the UK changed to no longer recommend 18

The impact of HIV infection on tuberculosis transmission in a country with low tuberculosis incidence: a national retrospective study using molecular epidemiology

“…Regardless of whether these HIV-positive cases are the ‘true’ first case in a cluster or merely the first case in a cluster to develop symptoms or present to care, the first observable patient is still a point at which interventions to diagnose patients earlier or investigate clusters can be targeted. National Institute for Health and Care Excellence guidelines currently suggest contact tracing is unnecessary for EPTB cases, and this is supported by a recent cost-effectiveness study [ 31 ]. However, our findings demonstrate that whilst EPTB cases may not drive transmission, EPTB cases with HIV can be the first observable case of a substantially larger cluster, which is important for directing cluster investigations.…”

Cost-effectiveness of active tuberculosis screening among high-risk populations in low tuberculosis incidence countries: a systematic review, 2008 to 2023

“…When the transmission rate was R = 1, the QALY was 56.3, costs EUR 1,802,624.06, ICER 1.63 and when R was 2, QALY was 43.7, costs EUR 31,941,233.29 and ICER was 18.7. Screening contacts of PTB cases was probably cost-effective at EUR 33,000 per QALY NICE threshold [ 16 ].…”

“…All the nine articles included were on active PTB cases in low-incidence countries in high-risk cohorts, such as people in prison, migrants, asylum seekers, youths in juvenile detention centres, nursing homes, people with substance use disorder, contacts of TB cases and isolated communities [15][16][17][18][19][20][21][22][23]. A summary of the articles reviewed is in Table 1.…”

“…Eight of the nine studies used chest X-ray (CXR) as the primary screening tool for active PTB [15][16][17][18][19][20][21][22]. Two studies from Canada targeted isolated community members and long-term care entrants [19,20].…”

“…Two studies from Canada targeted isolated community members and long-term care entrants [19,20]. Four studies from the United Kingdom (UK) involved foreign-born immigrants, contacts of PTB index cases, people with substance use disorder, people experiencing homelessness, people with lower incomes and PLHIV as a target population [15][16][17][18]. Additionally, studies from Italy and Germany involved migrants, while the Belgian study focused on migrants as well as on asylum…”