The Effectiveness and Cost-effectiveness of Screening for Active Tuberculosis Among Migrants in the EU/EEA: a Systematic Review

Overview

Journal Euro Surveill

Specialty Infectious Diseases

Date 2018 Apr 12

PMID 29637888

Citations 19

Authors

Christina Greenaway

Manish Pareek

Claire-Nour Abou Chakra

Moneeza Walji

Iuliia Makarenko

Balqis Alabdulkarim

Catherine Hogan

Ted McConnell

Brittany Scarfo

Robin Christensen

Anh Tran

Nick Rowbotham

Teymur Noori

Marieke J van der Werf

Kevin Pottie

Alberto Matteelli

Dominik Zenner

Rachael L Morton

Affiliations

Soon will be listed here.

Abstract

The foreign-born population make up an increasing and large proportion of tuberculosis (TB) cases in European Union/European Economic Area (EU/EEA) low-incidence countries and challenge TB elimination efforts. : We conducted a systematic review to determine effectiveness (yield and performance of chest radiography (CXR) to detect active TB, treatment outcomes and acceptance of screening) and a second systematic review on cost-effectiveness of screening for active TB among migrants living in the EU/EEA. : We identified six systematic reviews, one report and three individual studies that addressed our aims. CXR was highly sensitive (98%) but only moderately specific (75%). The yield of detecting active TB with CXR screening among migrants was 350 per 100,000 population overall but ranged widely by host country (110-2,340), migrant type (170-1,192), TB incidence in source country (19-336) and screening setting (220-1,720). The CXR yield was lower (19.6 vs 336/100,000) and the numbers needed to screen were higher (5,076 vs 298) among migrants from source countries with lower TB incidence (≤ 50 compared with ≥ 350/100,000). Cost-effectiveness was highest among migrants originating from high (> 120/100,000) TB incidence countries. The foreign-born had similar or better TB treatment outcomes than those born in the EU/EEA. Acceptance of CXR screening was high (85%) among migrants. : Screening programmes for active TB are most efficient when targeting migrants from higher TB incidence countries. The limited number of studies identified and the heterogeneous evidence highlight the need for further data to inform screening programmes for migrants in the EU/EEA.

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