A screening strategy for latent tuberculosis in healthcare workers: Cost-effectiveness and budget impact of universal versus targeted screening

Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America
May Ee PngNatasha Bagdasarian

Abstract

To evaluate the clinical, cost-efficiency, and budgetary implications of universal versus targeted latent tuberculosis infection (LTBI) screening strategies among healthcare workers (HCWs) in an intermediate tuberculosis (TB)-burden country. Pragmatic cost-effectiveness and budget impact analysis using decision-analytic modeling. A tertiary-care hospital in Singapore. We compared 7 potentially implementable LTBI screening programs including universal and targeted strategies with different screening frequencies. Feasible targeting methods included stratification by country of origin (a proxy for risk of prior TB exposure) and by high-risk occupation. The clinical and financial consequences of each strategy were estimated relative to "no screening" (current practice) and compared to locally appropriate cost-effectiveness thresholds. All analyses were conducted from the hospital's perspective over a 3-year time horizon, based on the typical hospital planning period. Parameter uncertainties were accounted for using sensitivity analyses. In our model, relative to current practice, screening new international hires and triennial screening of existing high-risk workers is most cost-effective (US$58 per quality adjusted life year [QALY...Continue Reading

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