PMD52 - Screening high-risk populations for Latent Tuberculosis: a systematic review of cost-utility analyses

Abstract

Efforts to reduce the tuberculosis (TB) burden in many countries have recently focused on screening high-risk groups for latent TB infection (LTBI). Clinicians generally use the tuberculin skin test (TST) or interferon-gamma release assay (IGRA) to aid in LTBI diagnosis. We performed a systematic review of cost-utility analyses in this area. Five electronic databases were used to identify studies. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Population, setting, model type, perspective, costs, screening and treatment parameters, and incremental cost-effectiveness ratios (ICERs) were extracted. All costs were adjusted to 2013 US dollars, with ICERs <$20,000 considered highly cost-effective, ICERs between $20,000 and $100,000 moderately cost-effective, and ICERs >$100,000 not cost-effective. Of 415 studies identified, 8 were included in the analysis, with 7 using Markov models and 1 using decision analysis. The decision to screen and how to screen for LTBI was evaluated in 5 studies, while the remaining three only evaluated how to screen. Perspectives used were societal (n=4), healthcare program (n=2), and healthcare system (n=2). Studies evaluating immigrants found adult screening highly cost-effective with a TST (n=1) and moderately cost-effective with an IGRA (n=1). Screening of the foreign-born (n=1) was moderately cost-effective with an IGRA until 44 years of age. Screening for HIV was found to be highly cost-effective with a TST (n=3) and moderately cost-effective with an IGRA (n=1). Screening in those with renal diseases (n=2) and diabetes (n=1) was found to be not cost-effective; screening in other immunocompromised populations was not cost-effective (n=1). Screening of HIV patients with a TST is highly cost-effective and screening of immigrants and foreign-born with an IGRA is moderately cost-effective. Screening of other immunocompromised populations is cost-prohibitive, however with minimal well-designed studies using consistent assumptions and parameters, these Conclusions should be interpreted cautiously.