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

Author

Listed:
  • Jad Shedrawy

    (Karolinska Institutet)

  • Charlotte Deogan

    (Karolinska Institutet
    The Public Health Agency of Sweden)

  • Joanna Nederby Öhd

    (Karolinska Institutet
    Stockholm County Council)

  • Maria-Pia Hergens

    (Karolinska Institutet
    Stockholm County Council)

  • Judith Bruchfeld

    (Karolinska University Hospital
    Karolinska Institutet)

  • Jerker Jonsson

    (The Public Health Agency of Sweden)

  • Andrew Siroka

    (World Health Organization)

  • Knut Lönnroth

    (Karolinska Institutet)

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.

Suggested Citation

  • Jad Shedrawy & Charlotte Deogan & Joanna Nederby Öhd & Maria-Pia Hergens & Judith Bruchfeld & Jerker Jonsson & Andrew Siroka & Knut Lönnroth, 2021. "Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(3), pages 445-454, April.
    • Handle: RePEc:spr:eujhec:v:22:y:2021:i:3:d:10.1007_s10198-021-01265-5
    DOI: 10.1007/s10198-021-01265-5
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    More about this item

    Keywords

    Latent tuberculosis; Cost-effectiveness; Screening; Migrants;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

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