International Journal of Tuberculosis and Lung Disease
Volume 22, Issue 4, 2018, Pages 429-436

Economic analysis of CDC's culture-And smear-based tuberculosis instructions for Filipino immigrants (Article)

Maskery B.* , Posey D.L. , Coleman M.S. , Asis R. , Zhou W. , Painter J.A. , Wingate L.T. , Roque M. , Cetron M.S.
  • a Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Building 16, Mailstop E-03, 1600 Clifton Road, Atlanta, GA 30333, United States
  • b Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Building 16, Mailstop E-03, 1600 Clifton Road, Atlanta, GA 30333, United States
  • c Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Building 16, Mailstop E-03, 1600 Clifton Road, Atlanta, GA 30333, United States
  • d St Lukes Medical Center Extension Clinic, Metro Manila, Philippines
  • e Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Building 16, Mailstop E-03, 1600 Clifton Road, Atlanta, GA 30333, United States
  • f Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Building 16, Mailstop E-03, 1600 Clifton Road, Atlanta, GA 30333, United States
  • g Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Building 16, Mailstop E-03, 1600 Clifton Road, Atlanta, GA 30333, United States
  • h St Lukes Medical Center Extension Clinic, Metro Manila, Philippines
  • i Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Building 16, Mailstop E-03, 1600 Clifton Road, Atlanta, GA 30333, United States

Abstract

SETTING: In 2007, the US Centers for Disease Control and Prevention (CDC) revised its tuberculosis (TB) technical instructions for panel physicians who administer mandatory medical examinations among US-bound immigrants. Many US-bound immigrants come from the Philippines, a high TB prevalence country. OBJECTIVE : To quantify economic and health impacts of smear- vs. culture-based TB screening. DESIGN: Decision tree modeling was used to compare three Filipino screening programs: 1) no screening, 2) smear-based screening, and 3) culture-based screening. The model incorporated pre-departure TB screening results from Filipino panel physicians and CDC databases with post-Arrival follow-up outcomes. Costs (2013 $US) were examined from societal, immigrant, US Public Health Department and hospitalization perspectives. RE SULT S : With no screening, an annual cohort of 35 722 Filipino immigrants would include an estimated 450 TB patients with 264 hospitalizations, at a societal cost of US$9.90 million. Culture-based vs. smear-based screening would result in fewer imported cases (80.9 vs. 310.5), hospitalizations (19.7 vs. 68.1), and treatment costs (US$1.57 million vs. US$4.28 million). Societal screening costs, including US follow-up, were greater for culture-based screening (US$5.98 million) than for smear-based screening (US$3.38 million). Culture-based screening requirements increased immigrant costs by 61% (US$1.7 million), but reduced costs for the US Public Health Department (22%, US$750 000) and of hospitalization (70%, US$1 020 000). CONCLUS ION: Culture-based screening reduced imported TB and US costs among Filipino immigrants. © 2018 The Union.

Author Keywords

Cost-effectiveness Costs Immigration Screening

Index Keywords

immigrant decision tree hospitalization Decision Trees Cost benefit analysis sputum smear mass screening economics public health service follow up human middle aged statistics and numerical data sputum culture priority journal Aged Databases, Factual factual database ethnology procedures United States Young Adult health care cost Health Care Costs migrant Humans Centers for Disease Control and Prevention (U.S.) Adolescent Infant, Newborn male Emigrants and Immigrants preschool child female tuberculosis Infant Child, Preschool newborn Article Filipino (people) major clinical study adult cost-benefit analysis Philippines cost effectiveness analysis Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85044933803&doi=10.5588%2fijtld.17.0453&partnerID=40&md5=8ecb61e6e3ae9f9fdcfe45833e297988
DOI: 10.5588/ijtld.17.0453
ISSN: 10273719
Original Language: English