Author
Listed:
- Jad Shedrawy
(Karolinska Institutet)
- Charlotte Deogan
(Karolinska Institutet
The Public Health Agency of Sweden)
- Joanna Nederby Öhd
(Karolinska Institutet
Stockholm County Council)
- Maria-Pia Hergens
(Karolinska Institutet
Stockholm County Council)
- Judith Bruchfeld
(Karolinska University Hospital
Karolinska Institutet)
- Jerker Jonsson
(The Public Health Agency of Sweden)
- Andrew Siroka
(World Health Organization)
- Knut Lönnroth
(Karolinska Institutet)
Abstract
Introduction The majority of tuberculosis (TB) cases in Sweden occur among migrants from endemic countries through activation of latent tuberculosis infection (LTBI). Sweden has LTBI-screening policies for migrants that have not been previously evaluated. This study aimed to assess the cost-effectiveness of the current screening strategy in Stockholm. Methods A Markov model was developed to predict the costs and effects of the current LTBI-screening program compared to a scenario of no LTBI screening over a 50-year time horizon. Epidemiological and cost data were obtained from local sources when available. The primary outcomes were incremental cost-effectiveness ratio (ICER) in terms of societal cost per quality-adjusted life year (QALY). Results Screening migrants in the age group 13–19 years had the lowest ICER, 300,082 Swedish Kronor (SEK)/QALY, which is considered cost-effective in Sweden. In the age group 20–34, ICER was 714,527 SEK/QALY (moderately cost-effectives) and in all age groups above 34 ICERs were above 1,000,000 SEK/QALY (not cost-effective). ICER decreased with increasing TB incidence in country of origin. Conclusion Screening is cost-effective for young cohorts, mainly between 13 and 19, while cost-effectiveness in age group 20–34 years could be enhanced by focusing on migrants from highest incidence countries and/or by increasing the LTBI treatment initiation rate. Screening is not cost-effective in older cohorts regardless of the country of origin.
Suggested Citation
Jad Shedrawy & Charlotte Deogan & Joanna Nederby Öhd & Maria-Pia Hergens & Judith Bruchfeld & Jerker Jonsson & Andrew Siroka & Knut Lönnroth, 2021.
"Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region,"
The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(3), pages 445-454, April.
Handle:
RePEc:spr:eujhec:v:22:y:2021:i:3:d:10.1007_s10198-021-01265-5
DOI: 10.1007/s10198-021-01265-5
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JEL classification:
- I10 - Health, Education, and Welfare - - Health - - - General
- I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
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