Abstract
ObjectiveTo assess the cost–effectiveness of the tuberculosis screening activities currently funded by the Flemish government in Flanders, Belgium.MethodsAfter estimating the expenses for 2013–2014 of each of nine screening components – which include high-risk groups, contacts and people who are seeking tuberculosis consultation at a centre for respiratory health care – and the associated costs per active case of tuberculosis identified between 2007 and 2014, we compared the cost–effectiveness of each component. The applied perspective was that of the Flemish government.FindingsThe three most cost-effective activities appeared to be the follow-up of asylum seekers who were found to have abnormal X-rays in initial screening at the Immigration Office, systematic screening in prisons and contact investigation. The mean costs of these activities were 5564 (95% uncertainty interval, UI: 3791–8160), 11 603 (95% UI: 9010–14 909) and 13 941 (95% UI: 10 723–18 201) euros (€) per detected active case, respectively. The periodic or supplementary initial screening of asylum seekers and the screening of new immigrants from high-incidence countries – which had corresponding costs of €51 813 (95% UI: 34 855–76 847), €126 236 (95% UI: 41 984–347 822) and €418 359 (95% UI: 74 975–1 686 588) – appeared much less cost-effective. Between 2007 and 2014, no active tuberculosis cases were detected during screening in the juvenile detention centres.ConclusionIn Flanders, tuberculosis screening in juvenile detention centres and among new immigrants and the periodic or supplementary initial screening of asylum seekers appear to be relatively expensive ways of detecting people with active tuberculosis.
Highlights
In 2014, the global incidence of tuberculosis was 133 cases per 100 000 population.[1]
Economic crises, growing inequity, increases in the incidence of diseases that are risk factors for tuberculosis and the dissemination of drug-resistant forms of Mycobacterium tuberculosis may all be contributing to an expansion in the burden posed by tuberculosis.[6,7,8,9]
On behalf of the Flemish government, the association carries out active detection through contact investigation, systematic screening of five high-risk groups and the screening of other individuals – hereafter called others – who, though they do not belong to any specific risk groups, have presented for a consultation at a centre for respiratory health care
Summary
In 2014, the global incidence of tuberculosis was 133 cases per 100 000 population.[1]. Low burdens of tuberculosis often lead to diminishing public awareness, inadequate political commitment, limited clinical and diagnostic expertise and the underfunding of tuberculosis research.[4,6] At the same time, economic crises, growing inequity, increases in the incidence of diseases that are risk factors for tuberculosis and the dissemination of drug-resistant forms of Mycobacterium tuberculosis may all be contributing to an expansion in the burden posed by tuberculosis.[6,7,8,9].
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