It Pays to Screen Immigrants for Tuberculosis

Especially immigrants entering the U.K. from countries with high incidence of the disease

THURSDAY, April 21 (HealthDay News) -- Screening immigrants to the United Kingdom for latent tuberculosis infection based on the incidence in their countries of origin is a cost-effective way of preventing future active cases of tuberculosis, according to a study published online April 21 in The Lancet.

Manish Pareek, M.R.C.P., from Imperial College London, and colleagues investigated the prevalence of latent tuberculosis infection in immigrants to the United Kingdom in order to identify which groups should be screened. Demographic and interferon-γ release-assay (IGRA) test results of 1,229 immigrants, aged 35 years or younger, were analyzed between 2008 and 2010. The cost effectiveness of screening was calculated based on tuberculosis incidence in immigrants' countries of origin.

The investigators found that IGRA screening was positive, negative, and intermediate in 20, 80, and 0.2 percent of immigrants, respectively. Positive results significantly and independently correlated with age, male gender, and increased tuberculosis incidence in immigrants' countries of origin. The most cost-effective screening strategies were to screen all immigrants from countries with incidence of more than 250 per 100,000 (incremental cost-effectiveness ratio was £17,956 [£1 = U.S.$1.60] per prevented case of tuberculosis), or to screen those from countries with an incidence of 150 per 100,000, which would prevent an additional 29.2 cases of disease per 10,000 immigrants at a cost of £20,818.8 per case averted.

"The outcomes and cost-effectiveness of immigrant screening with IGRA at different incidence thresholds showed that new entrants to the United Kingdom have a high prevalence of latent infection, which varies by age, sex, and tuberculosis incidence in their countries of origin," the authors write.

One of the study authors disclosed financial relationships with Oxford Immunotec Ltd., which commercialized the tuberculosis screening methods used in the study. One of the study authors invents patents used in T-cell-based diagnosis.

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