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A Systematic Review of Studies Evaluating the Cost Utility of Screening High-Risk Populations for Latent Tuberculosis Infection

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Abstract

Background

As tuberculosis screening trends to targeting high-risk populations, knowing the cost effectiveness of such screening is vital to decision makers.

Objectives

The purpose of this review was to compile cost-utility analyses evaluating latent tuberculosis infection (LTBI) screening in high-risk populations that used quality-adjusted life-years (QALYs) as their measure of effectiveness.

Data Sources

A literature search of MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Web of Knowledge, and PubMed was performed from database start to November 2014.

Inclusion Criteria

Studies performed in populations at high risk of LTBI and subsequent reactivation that used the QALY as an effectiveness measure were included.

Study Appraisal and Synthesis

Quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Data extracted included tuberculin skin test (TST) and/or interferon-gamma release assay (IGRA) use, economic, screening, treatment, health state, and epidemiologic parameters. Data were summarized in regard to consistency in model parameters and the incremental cost-effectiveness ratio (ICER), with costs adjusted to 2013 US dollars.

Results

Of 415 studies identified, ultimately eight studies were included in the review. Most took a societal perspective (n = 4), used lifetime time horizons (n = 6), and used Markov models (n = 8). Screening of adult immigrants was found to be cost effective with a TST in one study, but moderately cost effective with an IGRA in another study; screening immigrants arriving more than 5 years prior with an IGRA was moderately cost effective until 44 years of age (n = 1). Screening HIV-positive patients was highly cost effective with a TST (n = 1) and moderately cost effective with an IGRA (n = 1). Screening in those with renal diseases (n = 2) and diabetes (n = 1) was not cost effective.

Limitations

Very few studies used the QALY as their effectiveness measure. Parameter and study design inconsistencies limit the comparability of studies.

Conclusions

With validity issues in terms of parameters and assumptions, any conclusion should be interpreted with caution. Despite this, some cautionary recommendations emerged: screening HIV patients with a TST is highly cost effective, while screening adult immigrants with an IGRA is moderately cost effective.

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Authors and Affiliations

  1. University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada

    Jonathon R. Campbell, Thenuga Sasitharan & Fawziah Marra

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Correspondence to Fawziah Marra.

Ethics declarations

The authors have received no funding for the purposes of this review. JRC, TS and FM have no conflicts of interest to declare.

Author Contributions

JRC: Helped determine study objective and guide discussion points. Performed the literature review, quality assessment, data extraction, and data analysis. Did drafting of the initial manuscript and drafting of revisions. Guarantor of the overall content.

TS: Replicated the literature review, quality assessment, and data extraction to ensure accuracy. FM: Helped determine study objective and guide discussion points. Provided expert opinion and was heavily involved in initial and revision drafting.

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Campbell, J.R., Sasitharan, T. & Marra, F. A Systematic Review of Studies Evaluating the Cost Utility of Screening High-Risk Populations for Latent Tuberculosis Infection. Appl Health Econ Health Policy 13, 325–340 (2015). https://doi.org/10.1007/s40258-015-0183-4

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