Cost-effectiveness of tuberculosis infection screening and treatment among high-tuberculosis risk immigrants and asylum seekers in The Netherlands: A cohort modelling study
Series / Report no.
Open Access
Type
Journal Article
Article
Article
Language
en
Date
2025-07-07
Research Projects
Organizational Units
Journal Issue
Title
Cost-effectiveness of tuberculosis infection screening and treatment among high-tuberculosis risk immigrants and asylum seekers in The Netherlands: A cohort modelling study
Translated Title
Published in
J Infect Public Health 2025; 18(10):102889
Abstract
We evaluated the cost-effectiveness of TB infection (TBI) screening and TB preventive treatment (TPT) for immigrants, asylum seekers, and settled migrants in The Netherlands.
We used a deterministic cohort model that captures the natural history of TBI and TB disease for a migrant cohort in the country of origin (pre-entry) and in The Netherlands (post-entry). We fitted the pre-entry force of infection to Interferon Gamma Release Assay (IGRA) positivity rates from an implementation pilot study, and chest X-ray (CXR) positivity from the national entry-screening programme. We compared the costs per quality adjusted life year (QALY) gained for TBI screening with CXR screening over a 20-year time-horizon, accounting for parameter uncertainty by producing predictions for over 1000 unique parameter combinations that fit the data.
TBI screening uniformly resulted in an increase in QALYs gained compared to current CXR-based screening policies. For immigrants, <10 % of parameter combinations predicted TBI entry screening to be more cost-effective than CXR screening under observed TPT completion rates (36 %). However, this changed to nearly 100 % of parameter combinations for immigrants coming from countries with a TB incidence of ≥100 per 100,000 when applying TPT completion rates as observed in asylum seekers (72 %). For asylum seekers, 100 % of parameter combinations predicted cost-effectiveness, while 0 % predicted TBI screening to be cost-effective among settled migrants.
TBI entry screening is a cost-effective alternative to CXR entry screening for immigrants and asylum seekers coming from high TB endemic countries, provided TPT completion is sufficiently high.
We used a deterministic cohort model that captures the natural history of TBI and TB disease for a migrant cohort in the country of origin (pre-entry) and in The Netherlands (post-entry). We fitted the pre-entry force of infection to Interferon Gamma Release Assay (IGRA) positivity rates from an implementation pilot study, and chest X-ray (CXR) positivity from the national entry-screening programme. We compared the costs per quality adjusted life year (QALY) gained for TBI screening with CXR screening over a 20-year time-horizon, accounting for parameter uncertainty by producing predictions for over 1000 unique parameter combinations that fit the data.
TBI screening uniformly resulted in an increase in QALYs gained compared to current CXR-based screening policies. For immigrants, <10 % of parameter combinations predicted TBI entry screening to be more cost-effective than CXR screening under observed TPT completion rates (36 %). However, this changed to nearly 100 % of parameter combinations for immigrants coming from countries with a TB incidence of ≥100 per 100,000 when applying TPT completion rates as observed in asylum seekers (72 %). For asylum seekers, 100 % of parameter combinations predicted cost-effectiveness, while 0 % predicted TBI screening to be cost-effective among settled migrants.
TBI entry screening is a cost-effective alternative to CXR entry screening for immigrants and asylum seekers coming from high TB endemic countries, provided TPT completion is sufficiently high.