Bulletin of the World Health Organization
Volume 95, Issue 1, 2017, Pages 27-35

Cost-effectiveness of screening for active cases of tuberculosis in flanders, Belgium [Rentabilité du dépistage des cas de tuberculose active en flandre, en Belgique] [Rentabilidad de los exámenes de detección de casos activos de tuberculosis en flandes, Bélgica] (Article) (Open Access)

Smit G.S.A. , Apers L. , De Onate W.A. , Beutels P. , Dorny P. , Forier A.-M. , Janssens K. , Macq J. , Mak R. , Schol S. , Wildemeersch D. , Speybroeck N. , Devleesschauwer B.*
  • a Department of Virology, Parasitology and Immunology, Ghent University, Ghent, Belgium
  • b Institute of Tropical Medicine, Antwerp, Belgium
  • c Flemish Association for Respiratory Health and Tuberculosis Control, Brussels, Belgium
  • d Centre for Health Economics Research & Modelling Infectious Diseases, University of Antwerp, Antwerp, Belgium
  • e Institute of Tropical Medicine, Antwerp, Belgium
  • f Agency for Care and Health, Government of Flanders, Brussels, Belgium
  • g Flemish Association for Respiratory Health and Tuberculosis Control, Brussels, Belgium
  • h Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
  • i Agency for Care and Health, Government of Flanders, Brussels, Belgium
  • j Flemish Association for Respiratory Health and Tuberculosis Control, Brussels, Belgium
  • k Agency for Care and Health, Government of Flanders, Brussels, Belgium
  • l Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
  • m Scientific Institute of Public Health (WIV-ISP), Department of Public Health and Surveillance, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium

Abstract

Objective To assess the cost-effectiveness of the tuberculosis screening activities currently funded by the Flemish government in Flanders, Belgium. Methods After estimating the expenses for 2013-2014 of each of nine screening components-which include high-risk groups, contacts and people who are seeking tuberculosis consultation at a centre for respiratory health care-and the associated costs per active case of tuberculosis identified between 2007 and 2014, we compared the cost-effectiveness of each component. The applied perspective was that of the Flemish government. Findings The three most cost-effective activities appeared to be the follow-up of asylum seekers who were found to have abnormal X-rays in initial screening at the Immigration Office, systematic screening in prisons and contact investigation. The mean costs of these activities were 5564 (95% uncertainty interval, UI: 3791-8160), 11 603 (95% UI: 9010-14 909) and 13 941 (95% UI: 10 723-18 201) euros (∈) per detected active case, respectively. The periodic or supplementary initial screening of asylum seekers and the screening of new immigrants from high-incidence countries-which had corresponding costs of €51 813 (95% UI: 34 855-76 847), ∈126 236 (95% UI: 41 984-347 822) and ∈418 359 (95% UI: 74 975-1 686 588)-appeared much less cost-effective. Between 2007 and 2014, no active tuberculosis cases were detected during screening in the juvenile detention centres. Conclusion In Flanders, tuberculosis screening in juvenile detention centres and among new immigrants and the periodic or supplementary initial screening of asylum seekers appear to be relatively expensive ways of detecting people with active tuberculosis. © 2017, World Health Organization. All rights reserved.

Author Keywords

[No Keywords available]

Index Keywords

immigrant refugee Cost benefit analysis mass screening respiratory disease health care policy economics health risk human Refugees prisoner statistics and numerical data Prisoners nonhuman Undocumented Immigrants asylum seeker health care cost Humans undocumented immigrant tuberculosis risk factor Risk Factors spatiotemporal analysis Health Expenditures contact examination Belgium Flanders Contact Tracing Article organization and management health care thorax radiography government cost-benefit analysis public health program cost effectiveness

Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85008354881&doi=10.2471%2fBLT.16.169383&partnerID=40&md5=ac5021da6ae04fd19b7e815f96f4f2cd

DOI: 10.2471/BLT.16.169383
ISSN: 00429686
Cited by: 2
Original Language: English