Cost-effectiveness of screening for active cases of tuberculosis in Flanders, Belgium

G Suzanne A Smit; Ludwig Apers; Wouter Arrazola de Onate; Philippe Beutels; Pierre Dorny; An-Marie Forier; Kristien Janssens; Jean Macq; Ruud Mak; Sandrina Schol; Dirk Wildemeersch; Niko Speybroeck; Brecht Devleesschauwer

doi:10.2471/BLT.16.169383

Cost-effectiveness of screening for active cases of tuberculosis in Flanders, Belgium

G Suzanne A Smit, Ludwig Apers, Wouter Arrazola de Onate, Philippe Beutels, Pierre Dorny, An-Marie Forier, Kristien Janssens, Jean Macq, Ruud Mak, Sandrina Schol, Dirk Wildemeersch, Niko Speybroeck, Brecht Devleesschauwer

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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.

Original language	English
Journal	Bulletin of the World Health Organization
Volume	95
Issue number	1
Pages (from-to)	27-35
Number of pages	9
ISSN	0042-9686
DOIs	https://doi.org/10.2471/BLT.16.169383
Publication status	Published - 2017

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Smit, G. S. A., Apers, L., Arrazola de Onate, W., Beutels, P., Dorny, P., Forier, A.-M., Janssens, K., Macq, J., Mak, R., Schol, S., Wildemeersch, D., Speybroeck, N., & Devleesschauwer, B. (2017). Cost-effectiveness of screening for active cases of tuberculosis in Flanders, Belgium. Bulletin of the World Health Organization, 95(1), 27-35. https://doi.org/10.2471/BLT.16.169383

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title = "Cost-effectiveness of screening for active cases of tuberculosis in Flanders, 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.",

author = "Smit, {G Suzanne A} and Ludwig Apers and {Arrazola de Onate}, Wouter and Philippe Beutels and Pierre Dorny and An-Marie Forier and Kristien Janssens and Jean Macq and Ruud Mak and Sandrina Schol and Dirk Wildemeersch and Niko Speybroeck and Brecht Devleesschauwer",

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language = "English",

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Smit, GSA, Apers, L, Arrazola de Onate, W, Beutels, P, Dorny, P, Forier, A-M, Janssens, K, Macq, J, Mak, R, Schol, S, Wildemeersch, D, Speybroeck, N & Devleesschauwer, B 2017, 'Cost-effectiveness of screening for active cases of tuberculosis in Flanders, Belgium', Bulletin of the World Health Organization, vol. 95, no. 1, pp. 27-35. https://doi.org/10.2471/BLT.16.169383

TY - JOUR

T1 - Cost-effectiveness of screening for active cases of tuberculosis in Flanders, Belgium

AU - Smit, G Suzanne A

AU - Apers, Ludwig

AU - Arrazola de Onate, Wouter

AU - Beutels, Philippe

AU - Dorny, Pierre

AU - Forier, An-Marie

AU - Janssens, Kristien

AU - Macq, Jean

AU - Mak, Ruud

AU - Schol, Sandrina

AU - Wildemeersch, Dirk

AU - Speybroeck, Niko

AU - Devleesschauwer, Brecht

N1 - FTX

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

U2 - 10.2471/BLT.16.169383

DO - 10.2471/BLT.16.169383

M3 - A1: Web of Science-article

C2 - 28053362

SN - 0042-9686

VL - 95

SP - 27

EP - 35

JO - Bulletin of the World Health Organization

JF - Bulletin of the World Health Organization

IS - 1

ER -

Cost-effectiveness of screening for active cases of tuberculosis in Flanders, Belgium

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