Cost-Effectiveness of Tuberculosis Screening for Migrant Children in Low-Incidence countries

Abstract

Background: Tuberculosis (TB) screening programs in migrant children have become important, as the WHO recommends diagnosis and treatment of latent tuberculosis infection (LTBI), particularly in young children. This study evaluated the cost-effectiveness of TB screening for migrant children arriving in a low-incidence country. Methods: Retrospective analysis of a school-based TB screening program in Switzerland. Migrant children aged 5-18 years were screened using a tuberculin skin test (TST). Cost for TB screening and treatment were calculated from records of the University Children’s Hospital Basel. Cost impact was analyzed as the difference between cost of treatment for active TB and screening plus treatment of LTBI. Cost per disability-adjusted life years (DALY) was assessed based on 2013 Global Burden of Disease estimates. Results: 1120 children were screened with a mean age of 10.9 years; 46% were female. A TST induration ≥10 mm was documented in 78 (6.9%) cases, of which 21 (1.9%) were further evaluated. Of those, 17 children were diagnosed as LTBI and none had active TB. The highest rates of positive TST results were found in migrant children from Africa (16.6%) and Turkey (15.4%). Screening for LTBI was cost-saving for prevalence rates of 11% and higher; screening was cost-effective (cost per DALY Conclusion: School-based TB screening programs targeting migrant children from high-risk regions not only have the potential to prevent progression to active TB but can also reduce health system cost if LTBI prevalence is sufficiently high.