TITLE

Cost-effectiveness of tuberculosis evaluation and treatment of newly-arrived immigrants

AUTHOR(S)
Porco, Travis C.; Lewis, Bryan; Marseille, Elliot; Grinsdale, Jennifer; Flood, Jennifer M.; Royce, Sarah E.
PUB. DATE
January 2006
SOURCE
BMC Public Health;2006, Vol. 6, p157
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Immigrants to the U.S. are required to undergo overseas screening for tuberculosis (TB), but the value of evaluation and treatment following entry to the U.S. is not well understood. We determined the cost-effectiveness of domestic follow-up of immigrants identified as tuberculosis suspects through overseas screening. Methods: Using a stochastic simulation for tuberculosis reactivation, transmission, and follow-up for a hypothetical cohort of 1000 individuals, we calculated the incremental cost-effectiveness of follow-up and evaluation interventions. We utilized published literature, California Reports of Verified Cases of Tuberculosis (RVCTs), demographic estimates from the California Department of Finance, Medicare reimbursement, and Medi-Cal reimbursement rates. Our target population was legal immigrants to the United States, our time horizon is twenty years, and our perspective was that of all domestic health-care payers. We examined the intervention to offer latent tuberculosis therapy to infected individuals, to increase the yield of domestic evaluation, and to increase the starting and completion rates of LTBI therapy with INH (isoniazid). Our outcome measures were the number of cases averted, the number of deaths averted, the incremental dollar cost (year 2004), and the number of quality-adjusted life-years saved. Results: Domestic follow-up of B-notification patients, including LTBI treatment for latently infected individuals, is highly cost-effective, and at times, cost-saving. B-notification follow-up in California would reduce the number of new tuberculosis cases by about 6-26 per year (out of a total of approximately 3000). Sensitivity analysis revealed that domestic follow-up remains cost-effective when the hepatitis rates due to INH therapy are over fifteen times our best estimates, when at least 0.4 percent of patients have active disease and when hospitalization of cases detected through domestic follow-up is no less likely than hospitalization of passively detected cases. Conclusion: While the current immigration screening program is unlikely to result in a large change in case rates, domestic follow-up of B-notification patients, including LTBI treatment, is highly cost-effective. If as many as three percent of screened individuals have active TB, and early detection reduces the rate of hospitalization, net savings may be expected.
ACCESSION #
29362302

 

Related Articles

  • 'Test them all'.  // New Scientist;1/6/2007, Vol. 193 Issue 2585, p5 

    The article reports that specialists at the U.S. Centers for Disease Control and Prevention say that all U.S. immigrants should be screened as potential carriers of tuberculosis--regardless of how long they have lived there. The specialists believe that the country will never eliminate...

  • Immigration and the "Consumption" of a Nation. Maxwell, Andrea // Social Science Docket;Summer/Fall2009, Vol. 9 Issue 2, p35 

    The article reports on the impact of tuberculosis (TB), the disease caused by the Mycobacterium tuberculosis, on immigrants in the U.S. Due to the outbreak of TB, poorer immigrants were required to undergo medical screenings at the General Hospital on Ellis Island, New Jersey and New York to...

  • Increased risk of tuberculosis among foreign-born persons with diabetes in California, 2010-2012. Demlow, Sarah Ellen; Oh, Peter; Barry, Pennan M. // BMC Public Health;2015, Vol. 15 Issue 1, p1 

    Background: Diabetes increases the risk of tuberculosis. We sought to identify populations of persons with diabetes in California at further increased risk for tuberculosis to target tuberculosis infection screening and treatment efforts. Methods: We performed a retrospective population-based...

  • Quality Improvement of Tuberculosis Screening in Foreign-Born Patients. Kempker, Jordan; Pasquel, Francisco; Castejon, Maria; Acosta, Anna; Zaragoza-Macias, Elisa; Ilksoy, Nurcan; Higgins, Stacy; Tellez, Ildefonso // Journal of Immigrant & Minority Health;Feb2012, Vol. 14 Issue 1, p1 

    In the United States, a disproportionate percentage of tuberculosis (TB) cases occur in foreign-born persons. We implemented a performance improvement project to improve rates of screening for latent tuberculosis infection in a medical clinic. A questionnaire was developed to identify patients...

  • Policies for HPV screening and vax need to reworked in US.  // PharmacoEconomics & Outcomes News;11/27/2010, Issue 617, p14 

    The article focuses on a statement by Thomas J. Herzog from Columbia University College of Physicians & Surgeons and colleagues about the need to address gaps in policies for human papillomavirus (HPV) screening and vaccination in the U.S.

  • Testing overseas may explain big drop in TB cases. STOBBE, MIKE // Adirondack Daily Enterprise;3/20/2010, Vol. 117 Issue 68, pA11 

    The article reports on a drop in new tuberculosis cases in the U.S. due, probably, to the screening of immigrants and their treatment before they depart from their native countries.

  • Celebrating the ACP Centennial: From the Annals Archive. Cotton, Deborah // Annals of Internal Medicine;3/17/2015, Vol. 162 Issue 6, p452 

    An introduction is presented in which the editor discusses several topics including liking an article in each issue of the periodical with an earlier paper, tuberculosis (TB) screening program for immigrants and refugees in the U.S., and preparing false-positive TB smear.

  • The Colonoscamy - and What It Reveals About Our Medical System.  // Electronic Ardell Wellness Report (E-AWR);6/5/2013, Issue 648, p1 

    An essay is presented on the promotion and cost of colonoscopies in the U.S. and its implication for the country's medical system. It offers an overview of the procedures being performed in the routine screening test, with particular focus to the bills associated with colonoscopies. The author...

  • Postarrival Tuberculosis Screening of High-Risk Immigrants at a Local Health Department. Nuzzo, Jennifer B.; Golub, Jonathan E.; Chaulk, Patrick; Shah, Maunank // American Journal of Public Health;Jul2015, Vol. 105 Issue 7, p1432 

    Objectives. We sought to characterize postimmigration tuberculosis (TB) care for Class B immigrants and refugees at the Baltimore City Health Department TB program (BCHD), and to determine the proportion of immigrants with active TB or latent TB infection (LTBI) in this high-risk population....

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics