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A screening strategy for latent tuberculosis in healthcare workers: Cost-effectiveness and budget impact of universal versus targeted screening

Published online by Cambridge University Press:  21 February 2019

May Ee Png ,
Joanne Yoong ,
Catherine Wei Min Ong ,
Dale Fisher  and
Natasha Bagdasarian
May Ee Png
Affiliation:
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
Joanne Yoong*
Affiliation:
Center for Economic and Social Research East, University of Southern California, Washington, DC, United States
Catherine Wei Min Ong
Affiliation:
Division of Infectious Disease, Department of Medicine, National University Health System, Singapore, Singapore Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Dale Fisher
Affiliation:
Division of Infectious Disease, Department of Medicine, National University Health System, Singapore, Singapore Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Natasha Bagdasarian
Affiliation:
Division of Infectious Disease, Department of Medicine, National University Health System, Singapore, Singapore Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
*
Author for correspondence: Joanne Yoong, Email: jyoong@usc.edu
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Abstract

Objective:

To evaluate the clinical, cost-efficiency, and budgetary implications of universal versus targeted latent tuberculosis infection (LTBI) screening strategies among healthcare workers (HCWs) in an intermediate tuberculosis (TB)-burden country.

Design:

Pragmatic cost-effectiveness and budget impact analysis using decision-analytic modeling.

Setting:

A tertiary-care hospital in Singapore.

Methods:

We compared 7 potentially implementable LTBI screening programs including universal and targeted strategies with different screening frequencies. Feasible targeting methods included stratification by country of origin (a proxy for risk of prior TB exposure) and by high-risk occupation. The clinical and financial consequences of each strategy were estimated relative to “no screening” (current practice) and compared to locally appropriate cost-effectiveness thresholds. All analyses were conducted from the hospital’s perspective over a 3-year time horizon, based on the typical hospital planning period. Parameter uncertainties were accounted for using sensitivity analyses.

Results:

In our model, relative to current practice, screening new international hires and triennial screening of existing high-risk workers is most cost-effective (US$58 per quality adjusted life year [QALY]) and decreases active TB cases from 19 to 14. Screening all new hires combined with triennial universal screening, with or without annual high-risk screening or annual universal screening, reduced active TB to a range of 19 to 6 cases, but these strategies are less cost-effective and require substantially higher expenditures.

Conclusions:

Targeted LTBI screening for HCWs can be highly cost-effective for hospitals in settings similar to Singapore. More inclusive screening strategies (including regular universal screening) can yield better outcomes but are less efficient and may even be unaffordable.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 3 , March 2019 , pp. 341 - 349
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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