Abstract
Screening asylum seekers for infectious diseases is widely performed, but economic evaluations of such are scarce. We performed a policy analysis and economic evaluation of such screening in Germany, and analysed the effect of screening policies on cost differences between federal states. Of the 16 states, screening was compulsory for tuberculosis (TB) in asylum seekers ≥ 16 years of age in all states as well as in children < 16 years of age and pregnant women in six states, hepatitis B and enteropathogens in three, syphilis in two and human immunodeficiency virus (HIV) in one state. Of 441,899 asylum seekers, 88.0% were screened for TB, 22.9% for enteropathogens, 16.9% for hepatitis B, 13.1% for syphilis and 11.3% for HIV. The total costs for compulsory screening in 2015 were 10.3 million euros (EUR). Costs per case were highest for infections with Shigella spp. (80,200 EUR), Salmonella spp. (8,000 EUR), TB in those ≥ 16 years of age (5,300 EUR) and syphilis (1,150 EUR). States with extended screening had per capita costs 2.84 times those of states that exclusively screened for TB in asylum seekers ≥ 16 years of age (p < 0.0001, 95% confidence interval (CI): 1.96–4.10). Screening practices in Germany entailed high costs; evidence-based approaches to infectious disease screening are needed.
Highlights
Upon-entry medical screening of asylum seekers is a cornerstone of infectious disease control programmes in most countries of the European Union (EU) [1,2]
The highest estimated total cost for a medical screening measure was ca 5.3 million EUR for the initial chest X-ray in asylum seekers ≥16 years of age, followed by the costs for interferon gamma release assays (IGRAs) to rule out TB in children aged 5–15 years (2.0 million EUR), the costs for hepatitis B screening (1.9 million EUR) and the costs for stool examinations (0.8 million EUR) (Table 2)
Our study reveals substantial heterogeneity with respect to the range of compulsory screening tests stipulated by state policies and illustrates how this affects the proportion of asylum seekers screened as a consequence of the quota-based allocation system
Summary
Upon-entry medical screening of asylum seekers is a cornerstone of infectious disease control programmes in most countries of the European Union (EU) [1,2]. A synthesis of screening criteria proposed over the past 40 years demands that screening objectives be defined at the outset, that scientific evidence of screening effectiveness be integrated into clinical services, quality assurance, and programme management and evaluation [8]. Such criteria are especially important when screening is mandatory [7]
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