Cross-sectional study of prevalence and risk factors, and a cost-effectiveness evaluation of screening and preventive treatment strategies for latent tuberculosis among migrants in Singapore
Autor: | Yijun Lin, Hwee Lin Wee, Cynthia Be Chee, Vanessa W. Lim, Vernon J. Lee, Timothy Barkham, Mei Xuan Tan, Peiling Yap, Lydia Wenxin Lin, Rick Twee-Hee Ong, Yi Roe Tan, Phoebe Lee, Mark I-Cheng Chen |
---|---|
Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Adult
Tuberculosis Cost effectiveness Cross-sectional study Cost-Benefit Analysis Young Adult 03 medical and health sciences 0302 clinical medicine Latent Tuberculosis Risk Factors Prevalence Humans Mass Screening health economics Medicine 030212 general & internal medicine health care economics and organizations Transients and Migrants Singapore Health economics Latent tuberculosis Tuberculin Test business.industry public health General Medicine Middle Aged medicine.disease bacterial infections and mycoses Regimen Cross-Sectional Studies Infectious Diseases tuberculosis 030228 respiratory system Cohort Marital status business Demography |
Zdroj: | BMJ Open, Vol 11, Iss 7 (2021) BMJ Open |
ISSN: | 2044-6055 |
Popis: | ObjectivesWHO recommends that low burden countries consider systematic screening and treatment of latent tuberculosis infection (LTBI) in migrants from high incidence countries. We aimed to determine LTBI prevalence and risk factors and evaluate cost-effectiveness of screening and treating LTBI in migrants to Singapore from a government payer perspective.DesignCross-sectional study and cost-effectiveness analysis.SettingMigrants in Singapore.Participants3618 migrants who were between 20 and 50 years old, have not worked in Singapore previously and stayed in Singapore for less than a year were recruited.Primary and secondary outcome measuresCosts, quality-adjusted life-years (QALYs), threshold length of stay, incremental cost-effectiveness ratios (ICERs), cost per active TB case averted.ResultsOf 3584 migrants surveyed, 20.4% had positive interferon-gamma release assay (IGRA) results, with the highest positivity in Filipinos (33.2%). Higher LTBI prevalence was significantly associated with age, marital status and past TB exposure. The cost-effectiveness model projected an ICER of S$57 116 per QALY and S$12 422 per active TB case averted for screening and treating LTBI with 3 months once weekly isoniazid and rifapentine combination regimen treatment compared with no screening over a 50-year time horizon. ICER was most sensitive to the cohort’s length of stay in Singapore, yearly disease progression rates from LTBI to active TB, followed by the cost of IGRA testing.ConclusionsFor LTBI screening and treatment of migrants to be cost-effective, migrants from high burden countries would have to stay in Singapore for ~50 years. Risk-stratified approaches based on projected length of stay and country of origin and/or age group can be considered. |
Databáze: | OpenAIRE |
Externí odkaz: |