American Journal of Kidney Diseases
Volume 73, Issue 1, 2019, Pages 39-50

Screening for Latent Tuberculosis Infection in Migrants With CKD: A Cost-effectiveness Analysis (Article) (Open Access)

Campbell J.R. , Johnston J.C. , Ronald L.A. , Sadatsafavi M. , Balshaw R.F. , Cook V.J. , Levin A. , Marra F.*
  • a Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
  • b Faculty of Medicine, University of British Columbia, Vancouver, Canada, British Columbia Centre for Disease Control, Vancouver, Canada
  • c Faculty of Medicine, University of British Columbia, Vancouver, Canada, British Columbia Centre for Disease Control, Vancouver, Canada
  • d Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
  • e British Columbia Centre for Disease Control, Vancouver, Canada, George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
  • f Faculty of Medicine, University of British Columbia, Vancouver, Canada, British Columbia Centre for Disease Control, Vancouver, Canada
  • g Faculty of Medicine, University of British Columbia, Vancouver, Canada, British Columbia Provincial Renal Agency, Vancouver, Canada
  • h Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada

Abstract

Rationale & Objective: In countries with a low tuberculosis (TB) incidence, TB disproportionately affects populations born abroad. TB persists in these populations through reactivation of latent TB infection (LTBI) acquired before immigration. Those with chronic kidney disease (CKD) are at increased risk for reactivation and may benefit from LTBI screening and treatment. Study Design: Health administrative data from British Columbia, Canada, were used to inform a cost-effectiveness analysis evaluating LTBI screening in those diagnosed with stage 4 or 5 CKD not requiring dialysis (late-stage CKD) and those who began dialysis therapy. Setting & Population: Permanent residents establishing residency in British Columbia, Canada, between 1985 and 2012 who had late-stage CKD diagnosed or began dialysis therapy. Interventions: Screening with the tuberculin skin test or interferon-gamma release assay (IGRA) compared to no LTBI screening at the time of late-stage CKD diagnosis and time of dialysis therapy initiation. Treatment for those who tested positive was isoniazid for 9 months. Outcomes: Costs (2016 Can $), TB cases, and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio for QALYs gained was calculated. Model, Perspective, & Timeframe: Discrete event simulation model using a health care system perspective, 1.5% discount rate, and 5-year time horizon. Results: Screening with IGRA was superior to the tuberculin skin test in all situations. Screening with IGRA was less expensive and resulted in better outcomes compared to no screening in those initiating dialysis therapy from countries with an elevated TB incidence. In individuals with late-stage CKD, screening with IGRA was only cost-effective in those 60 years or older (cost per QALY gained, <$48,000) from countries with an elevated TB incidence. Limitations: This study has limitations in generalizability to different epidemiologic settings and in modeling complicated clinical decisions. Conclusions: LTBI screening should be considered in non–Canadian-born residents initiating dialysis therapy and those with late stage CKD who are older. © 2018 National Kidney Foundation, Inc.

Author Keywords

Screening Migrants cost-effectiveness analysis economic analysis quality-adjusted life-year (QALY) chronic kidney disease (CKD) Dialysis Tuberculosis (TB) latent tuberculosis infection (LTBI) reactivation Immigration prevention Canada Renal failure

Index Keywords

follow up human middle aged interferon gamma release assay sensitivity analysis screening test quality of life migrant treatment duration Canada latent tuberculosis Incidence Article adult tuberculin test isoniazid simulation renal replacement therapy outcome assessment chronic kidney failure time to treatment cost effectiveness analysis
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054030212&doi=10.1053%2fj.ajkd.2018.07.014&partnerID=40&md5=2389c7b1089326bb74af395a1f5c50eb
DOI: 10.1053/j.ajkd.2018.07.014
ISSN: 02726386
Cited by: 2
Original Language: English