Eurosurveillance
Volume 23, Issue 14, 2018

The effectiveness and cost-effectiveness of screening for active tuberculosis among migrants in the EU/EEA: A systematic review (Review) (Open Access)

Greenaway C.* , Pareek M. , Abou C.-N.C. , Walji M. , Makarenko I. , Alabdulkarim B. , Hogan C. , McConnell T. , Scarfo B. , Christensen R. , Tran A. , Rowbotham N. , Noori T. , van der Werf M.J. , Pottie K. , Matteelli A. , Zenner D. , Morton R.L.
  • a Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada, Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
  • b Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
  • c Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Québec, Canada
  • d Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
  • e Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
  • f Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
  • g Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada, Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
  • h Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
  • i Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
  • j Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
  • k National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
  • l National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
  • m European Centre for Disease Prevention and Control, Stockholm, Sweden
  • n European Centre for Disease Prevention and Control, Stockholm, Sweden
  • o C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
  • p Clinic of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, World Health Organization Collaborating Centre for TB/HIV and TB Elimination, Brescia, Italy
  • q Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom, Department of Infection and Population Health, University College London, London, United Kingdom
  • r National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia

Abstract

Background: The foreign-born population make up an increasing and large proportion of tuberculosis (TB) cases in European Union/European Economic Area (EU/EEA) low-incidence countries and challenge TB elimination efforts. Methods: We conducted a systematic review to determine effectiveness (yield and performance of chest radiography (CXR) to detect active TB, treatment outcomes and acceptance of screening) and a second systematic review on cost-effectiveness of screening for active TB among migrants living in the EU/EEA. Results: We identified six systematic reviews, one report and three individual studies that addressed our aims. CXR was highly sensitive (98%) but only moderately specific (75%). The yield of detecting active TB with CXR screening among migrants was 350 per 100,000 population overall but ranged widely by host country (110-2,340), migrant type (170-1,192), TB incidence in source country (19-336) and screening setting (220-1,720). The CXR yield was lower (19.6 vs 336/100,000) and the numbers needed to screen were higher (5,076 vs 298) among migrants from source countries with lower TB incidence (≤ 50 compared with ≥ 350/100,000). Cost-effectiveness was highest among migrants originating from high (≥ 120/100,000) TB incidence countries. The foreign-born had similar or better TB treatment outcomes than those born in the EU/EEA. Acceptance of CXR screening was high (85%) among migrants. Discussion: Screening programmes for active TB are most efficient when targeting migrants from higher TB incidence countries. The limited number of studies identified and the heterogeneous evidence highlight the need for further data to inform screening programmes for migrants in the EU/EEA. © 2018, European Centre for Disease Prevention and Control (ECDC). All rights reserved.

Author Keywords

[No Keywords available]

Index Keywords

refugee Cost benefit analysis mass screening economics Europe human infection rate Refugees interferon gamma release assay Interferon-gamma Release Tests geographic distribution screening test meta analysis health care cost health program Health Care Costs liver toxicity migrant Humans tuberculostatic agent Antitubercular Agents Treatment Outcome Emigrants and Immigrants latent tuberculosis tuberculosis Review diagnostic test accuracy study population research European Union sensitivity and specificity Incidence health care utilization infection prevention tuberculin test migration isoniazid drug safety thorax radiography Transients and Migrants rifampicin systematic review cost-benefit analysis cost effectiveness analysis
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85045896439&doi=10.2807%2f1560-7917.ES.2018.23.14.17-00542&partnerID=40&md5=8991c4e584def065e06d1192b6d1e8e7
DOI: 10.2807/1560-7917.ES.2018.23.14.17-00542
ISSN: 1025496X
Cited by: 16
Original Language: English