Abstract
BackgroundWhile persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis.ObjectivesWe evaluated the costs and benefits of expanding pre-departure tuberculosis screening requirements to a subset of NIVs who arrive from a moderate (Mexico) or high (India) incidence tuberculosis country with temporary work visas.MethodsWe developed a decision tree model to evaluate the program costs and estimate the numbers of active tuberculosis cases that may be diagnosed in the United States in two scenarios: 1) “Screening”: screening and treatment for tuberculosis among NIVs in their home country with recommended U.S. follow-up for NIVs at elevated risk of active tuberculosis; and, 2) “No Screening” in their home country so that cases would be diagnosed passively and treatment occurs after entry into the United States. Costs were assessed from multiple perspectives, including multinational and U.S.-only perspectives.ResultsUnder “Screening” versus “No Screening”, an estimated 179 active tuberculosis cases and 119 hospitalizations would be averted in the United States annually via predeparture treatment. From the U.S.-only perspective, this program would result in annual net cost savings of about $3.75 million. However, rom the multinational perspective, the screening program would cost $151,388 per U.S. case averted for Indian NIVs and $221,088 per U.S. case averted for Mexican NIVs.ConclusionFrom the U.S.-only perspective, the screening program would result in substantial cost savings in the form of reduced treatment and hospitalization costs. NIVs would incur increased pre-departure screening and treatment costs.
Highlights
While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis
A TB screening program (“Screening”) for NIV visa applicants in India (H-1B + H-4) and Mexico (H-2A + H2B) was estimated to avert 179 active TB cases from the United States annually if detection rates in NIVs are consistent with rates observed in the immigrant population
Under “No Screening,” the multinational costs associated with treating TB for NIVs from India are
Summary
While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis. Immigration from countries with high TB incidence maintains the close link between TB burden and disease incidence inside and outside the United States and supports the need to strengthen TB control efforts abroad [2]. Applicants for immigrant or refugee visas that lead to permanent residence in the United States, must undergo medical examinations (42 CFR 34) by panel physicians in accordance with the TB TIs [4]. Panel physicians are licensed physicians in the country of departure who have an agreement with the U.S consular section to perform the examination
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