Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 23;12(4):631.
doi: 10.3390/antibiotics12040631.

Screening for Tuberculosis Infection among Migrants: A Cost-Effectiveness Analysis in the Italian Context

Giulia Russo  1   2 , Valentina Marchese  1   3   4 , Beatrice Formenti  1   5 , Claudia Cimaglia  6 , Gianluca Di Rosario  1 , Irene Cristini  1 , Paola Magro  1 , Issa El-Hamad  1 , Daniela Maria Cirillo  2 , Enrico Girardi  6 , Alberto Matteelli  1   3
Affiliations

Screening for Tuberculosis Infection among Migrants: A Cost-Effectiveness Analysis in the Italian Context

Giulia Russo et al. Antibiotics (Basel). .

Abstract

Background: Screening of tuberculosis infection (TBI) among migrants from high-incidence countries is a cornerstone of tuberculosis control in low-incidence countries. However, the optimal screening strategy has not been defined yet.

Methods: A quasi-experimental study involving migrants residing in the province of Brescia was carried out that aimed at assessing the completion rate, time to completion, preventive treatment initiation rate, and cost-effectiveness of two strategies for TBI screening. They underwent TBI screening with the IGRA-only strategy (arm 1) or with the sequential strategy (tuberculin skin test, TST, followed by IGRA in case of a positive result-arm 2). The two strategies were compared in terms of screening completion, time to complete the screening process, therapy initiation, and cost-effectiveness.

Results: Between May 2019 and May 2022, 657 migrants were evaluated, and 599 subjects were included in the study, with 358 assigned to arm 1 and 237 to arm 2. Screening strategy was the only factor associated with screening completion in a multivariable analysis, with the subjects assigned to the IGRA-only strategy more likely to complete the screening cascade (n = 328, 91.6% vs. n = 202, 85.2%, IRR 1.08, 95% CI (1.01-1.14), p = 0.019). The time to complete the screening process was significantly longer for patients assigned to the sequential strategy arm (74 days vs. 46 days, p = 0.002). Therapy initiation did not significantly differ between the two arms, and cost-effectiveness was higher for the sequential strategy.

Conclusion: Sequential strategy implementation for TBI screening among migrants may be justified by its higher cost-effectiveness in spite of the lower completion of the screening cascade.

Keywords: Italy; TB infection; cost-effectiveness; migrant; screening; tuberculosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest. UNESCO disclaimer: The authors are responsible for the choice and presentation of views contained in this article and for opinions expressed therein, which are not necessarily those of UNESCO and do not commit the Organization.

Figures

Figure 1
Figure 1
Screening cascade.
See this image and copyright information in PMC

References

    1. Aldridge R.W., Zenner D., White P.J., Williamson E.J., Muzyamba M.C., Dhavan P., Mosca D., Thomas L.H., Lalor M.K., Abubakar I., et al. Tuberculosis in migrants moving from high-incidence to low-incidence countries: A population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland. Lancet. 2016;388:2510–2518. doi: 10.1016/S0140-6736(16)31008-X. - DOI - PMC - PubMed
    1. European Centre for Disease Prevention and Control, WHO Regional Office for Europe . Tuberculosis Surveillance and Monitoring in Europe 2022–2020 Data. WHO Regional Office for Europe and Stockholm, European Centre for Disease Prevention and Control; Copenhagen, Demark: 2022. Licence: CC BY 3.0 IGO.
    1. Marchese V., Rossi L., Formenti B., Magoni M., Caruana A., Sileo C., Lanfredini L., Castelli F., Matteelli A. Tuberculosis trend among native and foreign-born people over a 17 year period (2004–2020) in a large province in Northern Italy. Sci. Rep. 2021;11:23394. doi: 10.1038/s41598-021-02540-4. - DOI - PMC - PubMed
    1. Pontarelli A., Marchese V., Scolari C., Capone S., El-Hamad I., Donato F., Moioli R., Girardi E., Cirillo D.M., Castelli F., et al. Screening for active and latent tuberculosis among asylum seekers in Italy: A retrospective cohort analysis. Travel. Med. Infect. Dis. 2019;27:39–45. doi: 10.1016/j.tmaid.2018.10.015. - DOI - PubMed
    1. Vanino E., Tadolini M., Attard L., Po C., Francia F., Giannini A., Viale P. Systematic Tuberculosis Screening in Asylum Seekers in Italy. Clin. Infect. Dis. 2017;65:1407–1409. doi: 10.1093/cid/cix503. - DOI - PubMed

LinkOut - more resources