IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0189531.html

Some searches may not work properly. We apologize for the inconvenience.

   My bibliography  Save this article

Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area

Author

Listed:
  • Jun Li
  • Benjamin H K Yip
  • Chichiu Leung
  • Wankyo Chung
  • Kin On Kwok
  • Emily Y Y Chan
  • Engkiong Yeoh
  • Puihong Chung

Abstract

Background: Tuberculosis (TB) in the elderly remains a challenge in intermediate disease burden areas like Hong Kong. Given a higher TB burden in the elderly and limited impact of current case-finding strategy by patient-initiated pathway, proactive screening approaches for the high-risk group could be optimal and increasingly need targeted economic evaluations. In this study, we examined whether and under what circumstance the screening strategies are cost-effective compared with no screening strategy for the elderly at admission to residential care homes. Methods: A decision analytic process based on Markov model was adopted to evaluate the cost-effectiveness of four strategies: (i) no screening, (ii) TB screening (CXR) and (iii) TB screening (Xpert) represent screening for TB in symptomatic elderly by chest X-ray and Xpert® MTB/RIF respectively, and (iv) LTBI/TB screening represents screening for latent and active TB infection by QuantiFERON®-TB Gold In-Tube and chest X-ray. The target population was a hypothetical cohort of 65-year-old people, using a health service provider perspective and a time horizon of 20 years. The outcomes were direct medical costs, life-years and quality-adjusted life-years (QALYs) measured by incremental cost-effectiveness ratio (ICER). Results: In the base-case analysis, no screening was the most cost-saving; TB screening (CXR) was dominated by TB screening (Xpert); LTBI/TB screening resulted in more life-years and QALYs accrued. The ICERs of LTBI/TB screening were US$19,712 and US$29,951 per QALY gained compared with no screening and TB screening (Xpert), respectively. At the willingness-to-pay threshold of US$50,000 per QALY gained, LTBI/TB screening was the most cost-effective when the probability of annual LTBI reactivation was greater than 0.155% and acceptability of LTBI/TB screening was greater than 38%. In 1,000 iterations of Monte Carlo simulation, the probabilities of no screening, TB screening (CXR), TB screening (Xpert), and LTBI/TB screening to be cost-effective were 0, 1.3%, 20.1%, and 78.6% respectively. Conclusions: Screening for latent and active TB infection in Hong Kong elderly people at admission to residential care homes appears to be highly effective and cost-effective. The key findings may be the next key factor to bring down TB endemic in the elderly population among intermediate TB burden areas.

Suggested Citation

  • Jun Li & Benjamin H K Yip & Chichiu Leung & Wankyo Chung & Kin On Kwok & Emily Y Y Chan & Engkiong Yeoh & Puihong Chung, 2018. "Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-18, January.
    • Handle: RePEc:plo:pone00:0189531
    DOI: 10.1371/journal.pone.0189531
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189531
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0189531&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0189531?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Alice Zwerling & Richard G White & Anna Vassall & Ted Cohen & David W Dowdy & Rein M G J Houben, 2014. "Modeling of Novel Diagnostic Strategies for Active Tuberculosis – A Systematic Review: Current Practices and Recommendations," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-8, October.
    2. Frank A. Sonnenberg & J. Robert Beck, 1993. "Markov Models in Medical Decision Making," Medical Decision Making, , vol. 13(4), pages 322-338, December.
    3. Anonymous, 1999. "Long-Term Care for the Elderly," British Actuarial Journal, Cambridge University Press, vol. 5(2), pages 279-295, June.
    4. Richard A. Hirth & Michael E. Chernew & Edward Miller & A. Mark Fendrick & William G. Weissert, 2000. "Willingness to Pay for a Quality-adjusted Life Year," Medical Decision Making, , vol. 20(3), pages 332-342, July.
    5. Takeru Shiroiwa & Yoon‐Kyoung Sung & Takashi Fukuda & Hui‐Chu Lang & Sang‐Cheol Bae & Kiichiro Tsutani, 2010. "International survey on willingness‐to‐pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 422-437, April.
    6. Jonathon Campbell & Thenuga Sasitharan & Fawziah Marra, 2015. "A Systematic Review of Studies Evaluating the Cost Utility of Screening High-Risk Populations for Latent Tuberculosis Infection," Applied Health Economics and Health Policy, Springer, vol. 13(4), pages 325-340, August.
    7. Anna Vassall & Sanne van Kampen & Hojoon Sohn & Joy S Michael & K R John & Saskia den Boon & J Lucian Davis & Andrew Whitelaw & Mark P Nicol & Maria Tarcela Gler & Anar Khaliqov & Carlos Zamudio & Mar, 2011. "Rapid Diagnosis of Tuberculosis with the Xpert MTB/RIF Assay in High Burden Countries: A Cost-Effectiveness Analysis," PLOS Medicine, Public Library of Science, vol. 8(11), pages 1-14, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ryen, Linda & Svensson, Mikael, 2014. "The Willingness to Pay for a QALY: a Review of the Empirical Literature," Karlstad University Working Papers in Economics 12, Karlstad University, Department of Economics.
    2. Khachapon Nimdet & Nathorn Chaiyakunapruk & Kittaya Vichansavakul & Surachat Ngorsuraches, 2015. "A Systematic Review of Studies Eliciting Willingness-to-Pay per Quality-Adjusted Life Year: Does It Justify CE Threshold?," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-16, April.
    3. Svensson, Mikael & Hultkrantz, Lars, 2012. "The Willingness to Pay for a QALY - Results based on value of statistical life estimates in Sweden," Karlstad University Working Papers in Economics 2, Karlstad University, Department of Economics.
    4. Christian R. C. Kouakou & Thomas G. Poder, 2022. "Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(2), pages 277-299, March.
    5. Amaia Malet-Larrea & Estíbaliz Goyenechea & Miguel A. Gastelurrutia & Begoña Calvo & Victoria García-Cárdenas & Juan M. Cabases & Aránzazu Noain & Fernando Martínez-Martínez & Daniel Sabater-Hernández, 2017. "Cost analysis and cost-benefit analysis of a medication review with follow-up service in aged polypharmacy patients," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(9), pages 1069-1078, December.
    6. Fischer, Barbara & Telser, Harry & Zweifel, Peter & von Wyl, Viktor & Beck, Konstantin & Weber, Andreas, 2023. "The value of a QALY towards the end of life and its determinants: Experimental evidence," Social Science & Medicine, Elsevier, vol. 326(C).
    7. Theobald, Hildegard, 2005. "Social exclusion and care for the elderly: Theoretical concepts and changing realities in European welfare states," Discussion Papers, Research Group Public Health SP I 2005-301, WZB Berlin Social Science Center.
    8. Maria Rubio-Valera & María Teresa Peñarrubia-María & Maria Iglesias-González & Martin Knapp & Paul McCrone & Marta Roig & Ramón Sabes-Figuera & Juan V. Luciano & Juan M. Mendive & Ana Gabriela Murruga, 2019. "Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder: a multisite non-randomized-controlled trial in primary care (INFAP study)," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 703-713, July.
    9. Thomas Grochtdreis & Hans-Helmut König & Alexander Dobruschkin & Gunhild von Amsberg & Judith Dams, 2018. "Cost-effectiveness analyses and cost analyses in castration-resistant prostate cancer: A systematic review," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-25, December.
    10. Scott Johnson & Matthew Davis & Anna Kaltenboeck & Howard Birnbaum & ElizaBeth Grubb & Marcy Tarrants & Andrew Siderowf, 2011. "Early retirement and income loss in patients with early and advanced Parkinson’s disease," Applied Health Economics and Health Policy, Springer, vol. 9(6), pages 367-376, November.
    11. Hoy, Michael & Polborn, Mattias K., 2015. "The value of technology improvements in games with externalities: A fresh look at offsetting behavior," Journal of Public Economics, Elsevier, vol. 131(C), pages 12-20.
    12. Vincent T Janmaat & Marco J Bruno & Suzanne Polinder & Sylvie Lorenzen & Florian Lordick & Maikel P Peppelenbosch & Manon C W Spaander, 2016. "Cost-Effectiveness of Cetuximab for Advanced Esophageal Squamous Cell Carcinoma," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-10, April.
    13. Donald S Shepard & Yara A Halasa & Dina M Fonseca & Ary Farajollahi & Sean P Healy & Randy Gaugler & Kristen Bartlett-Healy & Daniel A Strickman & Gary G Clark, 2014. "Economic Evaluation of an Area-Wide Integrated Pest Management Program to Control the Asian Tiger Mosquito in New Jersey," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-11, October.
    14. Walter M. Cadette, 1999. "Financing Long-Term Care: Options for Policy," Economics Working Paper Archive wp_283, Levy Economics Institute.
    15. Malek B Hannouf & Chander Sehgal & Jeffrey Q Cao & Joseph D Mocanu & Eric Winquist & Gregory S Zaric, 2012. "Cost-Effectiveness of Adding Cetuximab to Platinum-Based Chemotherapy for First-Line Treatment of Recurrent or Metastatic Head and Neck Cancer," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-9, June.
    16. Hunt Allcott & Benjamin B Lockwood & Dmitry Taubinsky, 2019. "Regressive Sin Taxes, with an Application to the Optimal Soda Tax," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(3), pages 1557-1626.
    17. Bärnighausen, Till & Bloom, David E., 2009. ""Conditional scholarships" for HIV/AIDS health workers: Educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa," Social Science & Medicine, Elsevier, vol. 68(3), pages 544-551, February.
    18. Kevin Haninger & James K. Hammitt, 2011. "Diminishing Willingness to Pay per Quality‐Adjusted Life Year: Valuing Acute Foodborne Illness," Risk Analysis, John Wiley & Sons, vol. 31(9), pages 1363-1380, September.
    19. Arthur E. Attema & Marieke Krol & Job Exel & Werner B. F. Brouwer, 2018. "New findings from the time trade-off for income approach to elicit willingness to pay for a quality adjusted life year," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(2), pages 277-291, March.
    20. Lars Hein & Pete Roberts & Lucia Gonzalez, 2016. "Valuing a Statistical Life Year in Relation to Clean Air," Journal of Environmental Assessment Policy and Management (JEAPM), World Scientific Publishing Co. Pte. Ltd., vol. 18(04), pages 1-24, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0189531. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.