Cost-effectiveness of expanded latent TB infection testing and treatment: Lynn City, Massachusetts, USA

Health Impact and Cost-Effectiveness of Testing and Treatment of Mycobacterium Tuberculosis Infection Among Asian and Hispanic Persons With Diagnosed Diabetes in the United States

OBJECTIVES

To evaluate the cost-effectiveness of testing and treatment for Mycobacterium tuberculosis (Mtb) infection among Asian and Hispanic persons with diagnosed diabetes in the United States.

METHODS

We estimated population size and Mtb infection prevalence for Asian and Hispanic persons aged ≥15 years with diagnosed, nongestational diabetes, by age and US-born status. We assumed a 1-time test for Mtb infection intervention, with positive-testing persons offered treatment. Using a deterministic, transmission-dynamic model of incident tuberculosis (TB) in the United States, we estimated costs, TB cases and deaths averted, and quality-adjusted life years gained under the intervention compared with no intervention. We estimated incremental cost-effectiveness ratios (ICERs), calculated as costs per quality-adjusted life years gained, from a TB health services perspective, including diagnosis and treatment for TB infection and disease. We also assessed health services and societal perspectives. We estimated 95% uncertainty intervals via probabilistic sensitivity analysis.

RESULTS

TB cases averted per 100 000 persons tested ranged from 7.5 (95% uncertainty interval: 6.9-8.1) among US-born Hispanic persons to 238.9 (225.2-254.3) among non-US-born Asian persons. TB deaths averted per 100 000 persons tested ranged from 1.3 (1.2-1.4) among US-born Hispanic persons to 53.7 (51.4-56.1) among non-US-born Asian persons. ICERs for US-born Asian and Hispanic populations were $856 671 ($533 506-$1 234 032) and $1 081 646 ($673 142-$1 551 264), respectively. ICERs for non-US-born Asian and Hispanic populations were lower: $66 664 ($41 456-$93 625) and $68 749 ($43 136-$97 044), respectively. ICERs were 2% to 19% higher under a societal perspective.

CONCLUSIONS

Although the intervention produced health benefits for all populations assessed, health benefits were greater-and ICERs more favorable-for non-US-born Asian and Hispanic populations with diagnosed diabetes.

Effectiveness and Cost-Effectiveness of Expanded Targeted Testing and Treatment of Latent Tuberculosis Infection Among the Medicare Population in 2022

BACKGROUND

In the United States, older adults have elevated prevalence of latent tuberculosis infection (LTBI) and incidence of tuberculosis (TB).

OBJECTIVE

To estimate the health benefits and cost-effectiveness of LTBI testing and treatment among the Medicare-eligible population.

DESIGN

Model-based cost-effectiveness analysis.

DATA SOURCES

Nationally representative surveys and published evidence.

TARGET POPULATION

Medicare-eligible persons aged 65 years or older with at least 1 of 15 factors associated with elevated TB risk, as identified by guidelines from the U.S. Preventive Services Task Force (USPSTF) and other organizations.

TIME HORIZON

Lifetime.

PERSPECTIVE

Societal.

INTERVENTION

One-time offer of LTBI testing and treatment versus no intervention.

OUTCOME MEASURES

Lifetime TB cases and deaths averted, quality-adjusted life-years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs).

RESULTS OF BASE-CASE ANALYSIS

In 2022, there were an estimated 29.9 million Medicare-eligible persons (95% uncertainty interval [UI], 28.4 to 31.6 million persons) aged 65 years or older with elevated TB risks, including 14.7 million (95% UI, 13.4 to 16.0 million) with USPSTF-recommended factors. In the target population, 4.9 million persons (95% UI, 4.0 to 5.8 million persons) (16.4% [95% UI, 13.9% to 19.1%]) were estimated to have LTBI. Testing and treatment of LTBI was estimated to prevent 10 946 TB cases (95% UI, 4684 to 20 579 cases) and 2579 TB deaths (95% UI, 1106 to 4882 deaths), with 13 234 lifetime QALYs (95% UI, 5343 to 25 519 lifetime QALYs) gained. For the overall target population and for persons with USPSTF-recommended factors, ICERs were $192 000 (95% UI, $92 000 to $503 000) and $155 000 (95% UI, $77 000 to $393 000) per QALY gained, respectively.

RESULTS OF SENSITIVITY ANALYSIS

The ICER was $109 000 (95% UI, $49 000 to $285 000) per QALY gained for 65-year-olds newly eligible for Medicare.

LIMITATION

Health benefits from averted post-TB sequelae were not estimated.

CONCLUSION

Medicare-eligible persons represent approximately one third of all U.S. persons with LTBI. Testing and treatment of LTBI in this population could lead to substantial reductions in TB and TB-related mortality, particularly among 65-year-olds newly eligible for Medicare.

PRIMARY FUNDING SOURCE

Centers for Disease Control and Prevention.

Screening for latent tuberculosis in migrants-status quo and future challenges

OBJECTIVES

To review the evidence that migrants from tuberculosis (TB) high-incidence countries migrating to TB low-incidence countries significantly contribute to active TB cases in the counties of destination, primarily through reactivation of latent TB.

METHODS

This is a narrative review. The different screening programs in the countries of destination are reviewed either based on screening and preventive treatment of latent TB pre or more commonly - post arrival.

RESULTS

Screening can be performed using interferon-gamma release assays (IGRA) or tuberculin skin tests (TST). Preventive treatment of latent TB is using either monotherapy with isoniazid, or in combination with rifampicin or rifapentine. We discuss the ethical issues of preventive treatment in asymptomatic individuals and how these are addressed in different screening programs.

CONCLUSION

Screening migrants from TB high endemic countries to TB low endemic countries is beneficial. There is a lack of standardization and agreement on screening protocols, follow up and treatment.