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Gogichadze N, Sagrera A, Vicente JÁ, Millet JP, López-Seguí F, Vilaplana C. Cost-effectiveness of active tuberculosis screening among high-risk populations in low tuberculosis incidence countries: a systematic review, 2008 to 2023. Euro Surveill 2024; 29:2300614. [PMID: 38516785 PMCID: PMC11063676 DOI: 10.2807/1560-7917.es.2024.29.12.2300614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 03/23/2024] Open
Abstract
BackgroundIn countries with a low TB incidence (≤ 10 cases/100,000 population), active pulmonary tuberculosis (PTB) mostly affects vulnerable populations with limited access to healthcare. Thus, passive case-finding systems may not be successful in detecting and treating cases and preventing further transmission. Active and cost-effective search strategies can overcome this problem.AimWe aimed to review the evidence on the cost-effectiveness (C-E) of active PTB screening programmes among high-risk populations in low TB incidence countries.MethodsWe performed a systematic literature search covering 2008-2023 on PubMed, Embase, Center for Reviews and Dissemination, including Database of Abstracts of Reviews of Effects (DARE), National Health Services Economic Evaluation Database (NHS EED), Global Index Medicus and Cochrane Central Register of Controlled Trials (CENTRAL).ResultsWe retrieved 6,318 articles and included nine in this review. All included studies had an active case-finding approach and used chest X-ray, tuberculin skin test, interferon-gamma release assay and a symptoms questionnaire for screening. The results indicate that screening immigrants from countries with a TB incidence > 40 cases per 100,000 population and other vulnerable populations as individuals from isolated communities, people experiencing homelessness, those accessing drug treatment services and contacts, is cost-effective in low-incidence countries.ConclusionIn low-incidence countries, targeting high-risk groups is C-E. However, due to the data heterogenicity, we were unable to compare C-E. Harmonisation of the methods for C-E analysis is needed and would facilitate comparisons. To outline comprehensive screening and its subsequent C-E analysis, researchers should consider multiple factors influencing screening methods and outcomes.
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Affiliation(s)
- Nino Gogichadze
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute and Hospital (IGTP-HUGTIP), Badalona, Catalonia, Spain
- These authors contributed equally to the work and share the first authorship
- Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Catalonia, Spain
| | - Arnau Sagrera
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute and Hospital (IGTP-HUGTIP), Badalona, Catalonia, Spain
- These authors contributed equally to the work and share the first authorship
| | - José Ángel Vicente
- Research Group on Innovation, Health Economics and Digital Transformation (INEDIT), Institut de Recerca Germans Trias i Pujol, Badalona, Catalonia, Spain
- Fundació Lluita contra les Infeccions, Germans Trias i Pujol Research Institute and Hospital (IGTP-HUGTIP), Badalona, Catalonia, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Joan-Pau Millet
- Servei d'Epidemiologia, Agència de Salut Pública Barcelona (ASPB), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Francesc López-Seguí
- Research Group on Innovation, Health Economics and Digital Transformation (INEDIT), Institut de Recerca Germans Trias i Pujol, Badalona, Catalonia, Spain
- Fundació Lluita contra les Infeccions, Germans Trias i Pujol Research Institute and Hospital (IGTP-HUGTIP), Badalona, Catalonia, Spain
- Centre de Recerca en Economia de la Salut (CRES), Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Cristina Vilaplana
- Unitat de Tuberculosi Experimental, Germans Trias i Pujol Research Institute and Hospital (IGTP-HUGTIP), Badalona, Catalonia, Spain
- Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Catalonia, Spain
- Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord de l'Institut Català de la Salut, Badalona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Zumla A, Chakaya J, Khan M, Fatima R, Wejse C, Al-Abri S, Fox GJ, Nachega J, Kapata N, Knipper M, Orcutt M, Goscé L, Abubakar I, Nagu TJ, Mugusi F, Gordon AK, Shanmugam S, Bachmann NL, Lam C, Sintchenko V, Rudolf F, Amanullah F, Kock R, Haider N, Lipman M, King M, Maeurer M, Goletti D, Petrone L, Yaqoob A, Tiberi S, Ditiu L, Sahu S, Marais B, Issayeva AM, Petersen E. World Tuberculosis Day 2021 Theme - 'The Clock is Ticking' - and the world is running out of time to deliver the United Nations General Assembly commitments to End TB due to the COVID-19 pandemic. Int J Infect Dis 2021; 113 Suppl 1:S1-S6. [PMID: 33746094 DOI: 10.1016/j.ijid.2021.03.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Jeremiah Chakaya
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Razia Fatima
- National TB Control Program, Islamabad, Common Unit (HIV, TB, Malaria), Chak Shahzad, Islamabad, Pakistan.
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Oman.
| | - Greg J Fox
- WHO Collaborating Centre for Tuberculosis, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.
| | - Jean Nachega
- Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; University of Pittsburgh, Pittsburgh, PA, USA; University of Stellenbosch, South Africa.
| | - Nathan Kapata
- Ministry of Health, Zambia National Public Health Institute, Lusaka, Zambia.
| | - Michael Knipper
- Institute for the History of Medicine, University Justus Liebig Giessen, Germany.
| | - Miriam Orcutt
- Institute for Global Health, University College London, United Kingdom.
| | - Lara Goscé
- University College London, United Kingdom.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, United Kingdom.
| | - Tumaini Joseph Nagu
- Muhimbili University of Health and Allied Sciences Dar es Salaam, Dar es Salaam, Tanzania.
| | - Ferdinand Mugusi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Alice Kizny Gordon
- Centre for Infectious Diseases and Microbiology (CIDM), Institute of Clinical Pathology and Medical Research (ICPMR), The University of Sydney, New South Wales, Australia.
| | - Sivakumar Shanmugam
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India.
| | - Nathan Lloyd Bachmann
- Centre for Infectious Diseases and Microbiology (CIDM), University of Sydney, New South Wales, Australia.
| | - Connie Lam
- Institute of Clinical Pathology and Medical Research (ICPMR), Westmead, New South Wales, Australia.
| | - Vitali Sintchenko
- WHO Collaborating Centre for Tuberculosis, Marie Bashir Institute for Infectious Diseases and Biosecurity and Centre for Infectious Diseases and Microbiology (CIDM), University of Sydney, New South Wales, Australia.
| | - Frauke Rudolf
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark; Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau.
| | | | - Richard Kock
- Royal Veterinary College, Hatfield, United Kingdom.
| | - Najmul Haider
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Campus, Hatfield, United Kingdom.
| | - Marc Lipman
- Respiratory Medicine, Royal Free London NHS Foundation Trust, UCL Respiratory Medicine, University College London, London, United Kingdom.
| | - Michael King
- NTM Patient Care UK, The Grove Centre London, United Kingdom.
| | - Markus Maeurer
- Champalimaud Centre for the Unknown, Lisbon, Portugal; University of Mainz, Mainz, Germany.
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani"- IRCCS, Rome, Italy.
| | - Linda Petrone
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani"- IRCCS, Rome, Italy.
| | - Aashifa Yaqoob
- Common Management Unit (TB, HIV & Malaria), Islamabad, Pakistan.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
| | | | | | - Ben Marais
- WHO Collaborating Centre for Tuberculosis and the Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, New South Wales, Australia.
| | | | - Eskild Petersen
- Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark; European Society for Clinical Microbiology and Infectious Diseases, ESCMID, Basel, Switzerland; International Society for Infectious Diseases, ISID, Boston, USA.
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