Authors: Sara D. Khangura, Melissa Severn
BIA
budget impact analysis
HCW
health care worker
ICER
incremental cost-effectiveness ratio
LTBI
latent tuberculosis infection
QALY
quality-adjusted life-year
QFT
QuantiFERON-TB Gold In-Tube test
TB
tuberculosis
TST
tuberculosis skin test
In people at risk of occupational exposure to tuberculosis, targeted testing for latent tuberculosis infection (e.g., testing for high-risk individuals, testing after tuberculosis exposure) appears to be more cost-effective than repeated testing, such as testing once a year or every 3 years (findings based on 2 economic evaluations that assessed the cost-effectiveness of repeated latent tuberculosis infection screening in workers of health care settings).
Despite a low incidence of tuberculosis (TB) in the general population of many countries, the risk of contracting and/or transmitting the disease remains higher in some occupational settings — particularly health care. Health care workers (HCWs) may be serially screened for TB, although the optimal frequency for cost-effectiveness of serial testing for HCWs remains uncertain.
In June 2020, CADTH searched the literature for evidence describing the clinical utility, cost-effectiveness, and evidence-based guidelines concerning serial testing for latent tuberculosis infection (LTBI) in people with a risk of occupational exposure to TB.3 That report identified 2 economic evaluations and 3 evidence-based guidelines.3
The purpose of the current report is to summarize and critically appraise the economic evaluations identified previously4-6 to assess the cost-effectiveness of occupational screening for LTBI infection.
This report is a component of a larger condition-level review on TB. A CADTH condition-level review involves the identification, assessment, and summary of available evidence specific to a particular health condition, including describing disease prevention, diagnosis, treatment, and management. To learn more about CADTH’s condition-level review describing evidence on TB, please visit https://www.cadth.ca/tuberculosis.
What is the cost-effectiveness of serial testing for latent tuberculosis infection in people with a risk of occupational exposure to tuberculosis?
A limited literature search was conducted by an information specialist for a previous CADTH report,3 including key resources (i.e., MEDLINE via Ovid, the Cochrane Library, the University of York Centre for Reviews and Dissemination (CRD) databases, the websites of Canadian and major international health technology agencies, as well as a focused internet search. The search strategy comprised both controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. The main search concepts were tuberculosis testing and occupational testing. No filters were applied to limit the retrieval by study type. The search was also limited to English-language documents published between January 1, 2015 and June 1, 2020. Internet links were provided, where available.
The evidence in this report was identified in a previous CADTH report,3 for which 1 reviewer screened citations and abstracts. For the current report, the full-text articles were retrieved and reviewed by 1 reviewer and the final selection of full-text articles was based on the inclusion criteria presented in Table 1.
Criteria | Description |
Population | People with potential occupational exposure to tuberculosis (e.g., health care workers, staff in long-term care facilities, staff in prisons) |
Intervention | Serial testing for latent tuberculosis infection |
Comparator | Testing for latent tuberculosis infection at baseline or post-exposure; no testing for latent tuberculosis infection |
Outcomes | Cost-effectiveness (cost per health benefit) |
Study Designs | Health technology assessments, systematic reviews, economic evaluations |
Articles were excluded if they did not meet the selection criteria outlined in Table 1, were duplicate publications, or were published before 2015.
The included publications were critically appraised by 1 reviewer using the Drummond checklist for assessing economic evaluations.7 Summary scores were not calculated; rather, the strengths and limitations of each included study are described narratively.
In the previous CADTH report,8 a total of 462 citations were identified in the literature search and 5 potentially relevant publications were retrieved from the grey literature. Fourteen potentially relevant reports were identified and retrieved for full-text review, of which 2 economic evaluations4,5 met the inclusion criteria and were included in this report.
Both economic evaluations employed the use of cost-effectiveness analyses4,5 and the study by Png and colleagues additionally performed a budget impact analysis.4 Both studies used decision tree models incorporating data describing HCWs as the population of interest.4,5 Whereas the study by Mullie and colleagues used a health systems perspective, Png and colleagues used a tertiary hospital perspective.4,5
Png and colleagues considered a 3-year time horizon comparing a series of potentially feasible screening strategies in a Singaporean context — including various combinations of serial screening strategies (i.e., annual and triennial), together with screening for new and/or all HCWs — against a no-screening alternative, which was reported as the status quo at the time when the study was reported.4 The study assumed the use of only 1 type of test, the QuantiFERON-TB Gold In-Tube (QFT) test. This was because of the reported potential for compromised interpretation of the TB skin test (TST) owing to a particular childhood vaccine in the Singaporean schedule that may interfere with the accuracy of the TST.4 The hypothetical cohort of HCWs was reported as being 30 years of age and included 5,000 individuals working on the front lines of health care. Data sources included published literature, expert opinion, and hospital-based information.4 The study sought to describe cost-effectiveness using measures including active TB cases and quality-adjusted life-years (QALYs), with costs calculated in Singaporean dollars and converted to US dollars using a 3% discount rate for the cost-effectiveness analysis. Key assumptions in the model included a 9-to-1ratio of Singaporean to international HCWs, high-risk and low-risk categories among HCWs, the sensitivity and specificity of the QFT test, negative chest X-rays at each time point measurement, a consistent level of risk across the time horizon, adherence to treatment for those identified with LTBI; and no deaths, transmission, or recurrence of TB across the time horizon.4 The budget impact analysis (BIA) included a similar set of assumptions but also assumed a 10% turnover rate of HCW staff across the time horizon.4
Mullie et al. used a 20-year time horizon in a Canadian context, using 3 screening approaches with 2 types of tests across both low- and high-risk scenarios, for a total of 12 unique screening strategies.5 The screening included a serial, mixed serial, and non-serial approach (i.e., annual, once per year, for all HCWs); targeted (annual for high-risk HCWs and post-exposure-only for other HCWs), and post-exposure (post-exposure, only, for all HCWs). The test types assessed were the TST or the QFT; and low- and high-risk statuses for exposure to TB among HCWs were defined using published clinical data.5 The hypothetical cohort of 1,000 HCWs had a mean age of 35 years and was assumed to be 80% female.5 Cost-effectiveness was assessed using TB cases, costs of the screening programs, QALYs, mortality, and measures of test performance, with clinical and cost data drawn from published literature using 2015 Canadian dollars and a 3% discount rate.5 Key assumptions in the models included a negative baseline test for TB for all HCWs, diagnosis of all active TB cases, a consistent level of risk for acquiring TB across the time horizon (despite the actual level of risk likely being variable), 100% compliance with testing protocols, 75% identification of exposures, and treatment for all active TB cases.5
Additional details describing study characteristics are tabulated in Appendix 1.
Both of the economic evaluations included in this report demonstrated strengths and limitations.4,5 With regard to the study design, key details were clearly reported by both studies, including the research hypotheses, their economic importance, the chosen viewpoints for the analyses, the type of economic evaluations being used, and the alternative interventions being compared.4,5 However, neither study provided an explicit justification for the viewpoints selected, the alternative interventions chosen, or the type of economic evaluation selected.4,5
Similarly, parameters of effective data collection indicated both strengths and limitations in both studies; whereas primary outcomes and methods for valuing benefits and estimating quantities and costs were included in both studies, details describing the sources used to inform estimates — including information regarding the study design, populations, and results from these sources — were not provided by either study.4,5 And whereas currency and price information were clearly provided by both studies, details describing productivity changes and quantities of resources (separate from costs) were not reported by either study.4,5 Though, while Png and colleagues described details of their model — including a justification for key parameters selected4 — the paper by Mullie and colleagues did not explicitly provide this information.5
As it concerns the analysis and interpretation reported, both studies included critical information describing the time horizon, discount rate, sensitivity, and incremental analyses, as well as a description of the study’s limitations and conclusions that followed from the research hypotheses.4,5 However, while both studies failed to provide detail describing the use of statistical tests and/or confidence intervals,4,5 the report by Mullie and colleagues also failed to provide a justification for the selected discount rate, as well as a justification for the variables and ranges chosen to inform the sensitivity analyses.5 Further, the evaluation by and colleagues did not report major outcomes in both an aggregated and disaggregated format.5
Additional details describing critical appraisal are tabulated in Appendix 2.
Png and colleagues report that all of the screening strategies modelled were found to be cost-effective when compared to the no-screening status quo and in consideration of a US$50,000 willingness-to-pay threshold, although some strategies rendered more favourable scenarios than others.4 Study authors reported that a combined and targeted strategy of screening new hires plus triennial screening for existing, high-risk HCWs was found to be the most cost-effective, rendering an incremental cost-effectiveness ratio (ICER) value of US$58 per QALY, a cost of US$6,745 per case of TB avoided, and reducing the number of expected TB cases from 19 to 14 across the 3-year time horizon when compared to the no-screening status quo.4 The strategy involving the screening for all new hires plus the annual screening for all HCWs was reported to be the most costly, with an ICER value of US$311 per QALY and a cost of US$26,646 per case of TB avoided. But this strategy rendered the largest reduction in expected TB cases from 19 to 6 across the study time horizon as compared to the no-screening approach.4 The authors reported finding that the least cost-effective strategies were those that:
screen all new HCWs triennially upon their hire (i.e., an ICER of US$122 per QALY at a cost of US$53,926 per TB case avoided and a reduction in expected TB cases from 19 to 18)
screening new international hires and high-risk HCWs on an annual basis (i.e., an ICER of $157 at a cost of US$21,482 per TB case avoided and a reduction in expected TB cases from 19 to 13).4
These 2 strategies were considered dominated by the study authors and removed from further analyses.4 The cost-effectiveness analysis indicated that the cost of the QFT test accounted for the largest proportion of overall costs calculated.4 Data from the BIA were not available, but authors reported that the findings from the sensitivity analyses indicated that observations were most sensitive to changes in the number of HCWs and the rate of staff retention.4
Mullie and colleagues reported that all 6 of the screening strategies modelled using the QFT test were less cost-effective when compared to the 6 TST screening strategies; i.e., they were significantly more costly, with no appreciable added benefit, and had higher rates of false-positive test results. Using the TST across the 20-year time horizon, annual screening strategies were found to be less cost-effective than targeted or post-exposure approaches; i.e., in the base-case analysis, the total cost of the annual screening approach was CA$404,956, with 2.68 TB cases identified per 1,000 HCWs. This compared to a total cost of CA$151,517 and 2.83 TB cases identified per 1,000 HCWs using the targeted strategy and producing an incremental cost per additional TB case avoided of CA$1,717,539 for the annual as compared to the targeted screening strategy.5 In comparison with the targeted strategy, the total cost for the post-exposure screening strategy was CA$198,480, with 3.03 TB cases identified per 1,000 HCWs, producing an incremental cost of CA$426,678 per additional TB case avoided using the targeted strategy.5 In the alternate scenario analyses, the total cost of the annual screening approach using TST was CA$487,837, with 7.64 TB cases identified per 1,000 HCWs. This compared to a total cost of CA$257,670 and 8.18 TB cases identified per 1,000 HCWs using the targeted strategy and producing an incremental cost per additional TB case avoided of CA$426,678 for the annual as compared to the targeted screening strategy.5 The total cost for the post-exposure screening strategy with TST was CA$198,480, with 8.90 TB cases identified per 1,000 HCWs, resulting in an incremental cost per additional TB case avoided of CA$52,552 for the targeted as compared to the post-exposure strategy.5 The authors noted that there were no significant differences among any of the screening strategies with regard to mortality — either resulting from active TB or treatments administered for active TB or LTBI.5
Additional details describing study findings are tabulated in Appendix 3.
This report is limited by the amount of evidence identified describing the cost-effectiveness of occupational screening for LTBI; i.e., 2 economic evaluations demonstrating both strengths and limitations were found to be eligible and have been described herein. While this report sought information on occupational screening in general, the eligible studies identified assessed screening only in the health care occupational settings,4,5 with no eligible studies found describing the cost-effectiveness of screening in other occupational settings (e.g., correctional facilities).
Of the 2 economic evaluations, 1 bears clear applicability to the Canadian context,5 while the other has limited applicability, given the objectives and assumptions informing those analyses (e.g., the health care human resources, risk probabilities, and current approaches to screening for LTBI in occupational settings), which are not comparable to those in Canada.4 And though the study reported by Mullie and colleagues provides information applicable to the Canadian context, the critical appraisal identified some missing details that would inform a more robust assessment of its utility in various settings across Canadian health jurisdictions.5
As with all economic models (and other mathematical models, in general), the accuracy of the estimates reported are limited by the extent to which the input variables are consistent with real-world circumstances in a particular context, and so are subject to a potential for at least some threshold of error.9
Two economic evaluations4,5 were identified by an earlier CADTH report,3 then summarized and critically appraised in this report. Both studies assessed the cost-effectiveness of screening for LTBI in HCWs using either a hospital perspective4 or a health systems perspective.5 No evidence was identified assessing the cost-effectiveness of screening for LTBI in other occupational settings (e.g., corrections facilities).
Notably, the 2 studies included and described in this report were conducted within very different health system and societal contexts (i.e., Singapore and Canada), with different risk profiles for TB that affect both the general population and HCWs: whereas Singapore is described as a country with an intermediate burden of TB,4 Canada is described as a low-risk country for TB.5 These macro-level risks are important considerations when assessing the applicability of the evidence that has been generated, as the cost-effectiveness estimates produced using a Canadian health systems approach are likely to have greater utility in the Canadian context.
In general, the 2 economic evaluations assessed by this review reported that serial approaches to health care occupational screening for LTBI are likely to be more costly, less beneficial, and therefore less cost-effective than those that are more targeted.4,5 While the current approaches to occupational screening for LTBI in Canada vary across settings and jurisdictions,10-12 current guidance specific to health care occupational settings at the federal level from the Public Health Agency of Canada recommends screening for new HCWs and either serial or targeted screening approaches thereafter, depending on the level of risk and other contextual factors.13 And whereas the cost-effectiveness evidence identified for this report and applicable to the Canadian context is limited, considered alongside these current recommendations, an assessment of risk and a tailored screening strategy are likely to be important measures for ensuring an optimally cost-effective approach to occupational health care screening for LTBI in any particular health care setting in Canada.
While more research may benefit the accuracy of estimates of cost-effectiveness for occupational LTBI screening, tailored approaches to assessing cost-effectiveness that are specific to particular occupational settings and use a combination of local and population-level data are likely to be optimal.
1.Park JS. The Prevalence and Risk Factors of Latent Tuberculosis Infection among Health Care Workers Working in a Tertiary Hospital in South Korea. Tuberc Respir Dis (Seoul). 2018;81(4):274-280. PubMed
2.Dobler CC, Farah WH, Alsawas M, et al. Tuberculin Skin Test Conversions and Occupational Exposure Risk in US Healthcare Workers. Clin Infect Dis. 2018;66(5):706-711. PubMed
3.Kumar D, Severn M. Occupational Screening for Latent Tuberculosis: Clinical Utility, Cost-Effectiveness, and Guidelines. CADTH rapid response report: summary of abstracts. Ottawa: CADTH; 2020 Jun https://www.cadth.ca/sites/default/files/pdf/htis/2020/RB1495%20Frequency%20of%20TB%20Screening%20for%20Low%20Risk%20Final.pdf. Accessed 9 June 2021.
4.Png ME, Yoong J, Ong CWM, Fisher D, Bagdasarian N. A screening strategy for latent tuberculosis in healthcare workers: Cost-effectiveness and budget impact of universal versus targeted screening. Infect Control Hosp Epidemiol. 2019;40(3):341-349. PubMed
5.Mullie GA, Schwartzman K, Zwerling A, N'Diaye DS. Revisiting annual screening for latent tuberculosis infection in healthcare workers: a cost-effectiveness analysis. BMC Med. 2017;15(1):104. PubMed
6.Sosa LE, Njie GJ, Lobato MN, et al. Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. MMWR Morb Mortal Wkly Rep. 2019;68(19):439-443. PubMed
7.Higgins JPT, Green S, editors. Figure 15.5.a: Drummond checklist (Drummond 1996). Cochrane handbook for systematic reviews of interventions. London (GB): The Cochrane Collaboration; 2011: http://handbook-5-1.cochrane.org/chapter_15/figure_15_5_a_drummond_checklist_drummond_1996.htm. Accessed 20 Aug 2021.
8.Ogawa H, Urushibara T, Kasai H, Ikeda H, Shinozaki T. Pulmonary Cryptococcosis in a Nurse Initially Suspected of Having Pulmonary Tuberculosis. Am J Case Rep. 2020;21:e919267. PubMed
9.Eddy D. Bringing Health Economic Modeling to the 21st Century. Value in Health. 2006;9(3):168-178. PubMed
10.Ontario Hospital Association. Tuberculosis Surveillance Protocol for Ontario Hospitals. 2018: https://www.oha.com/Documents/Tuberculosis%20Protocol%20(June%202018).pdf. Accessed 18 June 2021.
11.BC Centre for Disease Control. BC Centre for Disease Control (BCCDC) Non-Certified Practice Decision Support Tool (DST) Tuberculosis. 2019: http://www.bccdc.ca/resource-gallery/Documents/Communicable-Disease-Manual/Chapter%204%20-%20TB/4.0b%20TB%20Screening%20DST.pdf. Accessed 18 June 2021.
12.Government of Newfoundland and Labrador. Guideline for Preventing the Transmission of Mycobacterium tuberculosis across the Continuum of Care. 2019: https://www.gov.nl.ca/hcs/files/publichealth-cdc-tuberculosis-management.pdf. Accessed 18 June 2021.
13.Government of Canada. Chapter 15: Canadian Tuberculosis Standards 7th Edition: 2014 – Prevention and control of Tuberculosis transmission in health care and other settings. 2017: https://www.canada.ca/en/public-health/services/infectious-diseases/canadian-tuberculosis-standards-7th-edition/edition-11.html#s7-2. Accessed 18 June 2021.
Table 2: Characteristics of Included Economic Evaluations
Study citation country, funding source | Type of analysis, time horizon, perspective | Population characteristics | Intervention and comparator(s) | Approach | Source of clinical, cost, and utility data used in analysis | Main assumptions |
Png et al. (2019)4 Country: Singapore Funding: Reported as none | Analysis type: cost-effectiveness and budget impact analysis Time horizon: 3yrs Perspective: Tertiary care hospital | Population: 5,000 frontline Singaporean HCWs Age: 30yrs Sex: NR | Interventions:
| Decision analysis model using TreeAge software BIA using MS Excel Outcomes:
Costs in 2016 Singaporean dollars converted to 2016 USD using a 3% discount rate and considering $50,000 as the willingness-to-pay/cost-effectiveness threshold; BIA used undiscounted costs | Clinical data sources: published literature, expert opinion and hospital-based data Cost data: Hospital-based data Utility data: NR |
BIA:
|
Comparator: no screening | Sensitivity analyses:
| |||||
Mullie et al. (2017)5 Country: Canada Funding sources: McGill University; Canadian Institutes for Health Research |
|
|
| Decision analysis model using TreeAge software Outcomes:
Costs in 2015 Canadian dollars using a 3% discount rate | Clinical data source: US- and Italian-based data from across a 30yr timespan considering both higher- and lower-risk scenarios Cost data source: published North American values Utility data source: NR | All HCWs had a negative baseline test Base case assumptions:
|
Sensitivity analyses:
|
BIA = budget impact analysis; CEA = cost-effectiveness analysis; HCW = health care worker; ICER = incremental cost-effectiveness ratio; LTBI = latent tuberculosis infection; NR = not reported; QALY = quality-adjusted life-year; QFT = Quantiferon-TB Gold-In-Tube test; TB = tuberculosis; TST = tuberculosis skin test; USD = US dollars; yrs = years.
Note that this appendix has not been copy-edited.
Note that this appendix has not been copy-edited.
Table 3: Strengths and Limitations of Economic Evaluations Using the Drummond Checklist7
Strengths | Limitations |
Png et al. (2019)4 | |
Study design
Data collection
Analysis and interpretation
| Study design
Data collection
Analysis and interpretation
|
Mullie et al. (2017)5 | |
Study design
Data collection
Analysis and interpretation
| Study design
Data collection
Analysis and interpretation
|
Note that this appendix has not been copy-edited.
Base Case (per 5,000 HCWs across 3 years using QFT exclusively)
New
TB cases (Number [N])
18
TB cases averted (N)
1
Cost per HCW (USD)
55
Incremental cost (US dollars)
9
Incremental cost/TB case averted (US dollars)
53,926
QALYs per HCW
2.98
Incremental QALYs
0.07
ICER (US dollars/QALY)
122
New international + triennial high-risk
TB cases (N)
14
TB cases averted (N)
5
Cost per HCW (US dollars)
53
Incremental cost (US dollars)
7
Incremental cost/TB case averted (US dollars)
6,745
QALYs per HCW
3.03
Incremental QALYs
0.12
ICER (US dollars/QALY)
58
New international + annual high-risk
TB cases (N)
13
TB cases averted (N)
6
Cost per HCW (US dollars)
70
Incremental cost (US dollars)
24
Incremental cost/TB case averted (US dollars)
21,482
QALYs per HCW
3.07
Incremental QALYs
0.15
ICER (US dollars/QALY)
157
New + triennial universal
TB cases (N)
7
TB cases averted (N)
12
Cost per HCW (US dollars)
86
Incremental cost (US dollars)
40
Incremental cost/TB case averted (US dollars)
16,298
QALYs per HCW
3.09
Incremental QALYs
0.18
ICER (US dollars/QALY)
223
New + triennial universal + annual high-risk
TB cases (N)
6
TB cases averted (N)
13
Cost per HCW (US dollars)
103
Incremental cost (US dollars)
57
Incremental cost/TB case averted (US dollars)
22,657
QALYs per HCW
3.12
Incremental QALYs
0.21
ICER (US dollars/QALY)
275
New + annual universal
TB cases (N)
6
TB cases averted (N)
13
Cost per HCW (US dollars)
113
Incremental cost (US dollars)
67
Incremental cost/TB case averted (US dollars)
26,646
QALYs per HCW
3.13
Incremental QALYs
0.22
ICER (USD/QALY)
311
No screening
TB cases (N)
19
TB cases averted (N)
Not applicable (N/A)
Cost per HCW (US dollars)
46
Incremental cost (US dollars)
N/A
Incremental cost/TB case averted (US dollars)
N/A
QALYs per HCW
2.91
Incremental QALYs
N/A
ICER (USD/QALY)
N/A
“Targeted LTBI screening for HCWs can be highly cost-effective for hospitals in settings similar to Singapore. More inclusive screening strategies (including regular universal screening) can yield better outcomes but are less efficient and may even be unaffordable.” (p. 341)
Base Case (per 1,000 HCWs across 20 years)
Annual screening
New active cases
TST
2.68
QFT
2.80
Cost (Canadian dollars)
TST
404,956
QFT
817,695
QALYs
TST
15,231.85
QFT
15,227.92
ICER (per additional TB case prevented)
TST
$1,717,539
Active TB-related mortality
TST
0.12
QFT
0.12
TB treatment-related mortality: Active
TST
0.0020
QFT
0.0021
TB treatment-related mortality: Latent
TST
0.00258
QFT
0.00362
Test performance: True-positive results
TST
75
QFT
64
Test performance: False-positives
TST
413
QFT
607
Targeted screening
New active cases
TST
2.83
QFT
2.86
Cost (Canadian dollars)
TST
151,517
QFT
263,660
QALYs
TST
15,237.96
QFT
15,236.90
ICER (per additional TB case prevented)
TST
$517,437
Active TB-related mortality
TST
0.36
QFT
0.36
TB treatment-related mortality: Active
TST
0.0063
QFT
0.0063
TB treatment-related mortality: Latent
TST
0.00152
QFT
0.00177
Test performance: True-positive results
TST
193
QFT
184
Test performance: False-positive results
TST
96
QFT
146
Post-exposure screening
New active cases
TST
8.90
QFT
8.73
Cost (Canadian dollars)
TST
198,480
QFT
228,809
QALYs
TST
15,234.05
QFT
15,233.75
ICER (per additional TB case prevented)
QFT
$197,017
Active TB-related mortality
TST
0.13
QFT
0.13
TB treatment-related mortality: Active
TST
0.0023
QFT
0.0023
TB treatment-related mortality: Latent
TST
0.00036
QFT
0.00040
Test performance: True-positive results
TST
63
QFT
67
Test performance: False-positive results
TST
6
QFT
11
Alternate scenario (per 1,000 HCWs across 20 years)
Annual screening
New active cases
TST
7.64
QFT
7.95
Cost (Canadian dollars)
TST
487,837
QFT
868,662
QALYs
TST
15,227.38
QFT
15,223.94
ICER (per additional TB case prevented)
TST
$426,678
Active TB-related mortality
TST
0.33
QFT
0.35
TB treatment-related mortality: Active
TST
0.0058
QFT
0.0061
TB treatment-related mortality: Latent
TST
0.00307
QFT
0.00395
Test performance: True-positive results
TST
203
QFT
174
Test performance: False-positive results
TST
373
QFT
553
Targeted screening
New active cases
TST
8.18
QFT
8.23
Cost (Canadian dollars)
TST
257,670
QFT
365,397
QALYs
TST
15,232.84
QFT
15,231.90
ICER (per additional TB case prevented)
TST
$52,552
Active TB-related mortality
TST
0.36
QFT
0.36
TB treatment-related mortality: Active
TST
0.0063
QFT
0.0063
TB treatment-related mortality: Latent
TST
0.00152
QFT
0.00177
Test performance: True-positive results
TST
193
QFT
184
Test performance: False-positive results
TST
96
QFT
146
Post-exposure screening
New active cases
TST
8.90
QFT
8.73
Cost (Canadian dollars)
TST
198,480
QFT
228,809
QALYs
TST
15,234.05
QFT
15,233.75
ICER (per additional TB case prevented)
QFT
Extended dominance (ICER, otherwise not reported)
Active TB-related mortality
TST
0.39
QFT
0.38
TB treatment-related mortality: Active
TST
0.0068
QFT
0.0067
TB treatment-related mortality: Latent
TST
0.00109
QFT
0.00119
Test performance: True-positive results
TST
195
QFT
201
Test performance: False-positive results
TST
17
QFT
30
“For most North American healthcare workers, annual tuberculosis screening appears poorly cost-effective. Reconsideration of screening practices is warranted.” (p. 1 of 15)
ISSN: 2563-6596
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This disclaimer and any questions or matters of any nature arising from or relating to the content or use (or misuse) of this document will be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and all proceedings shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, Canada.
The copyright and other intellectual property rights in this document are owned by CADTH and its licensors. These rights are protected by the Canadian Copyright Act and other national and international laws and agreements. Users are permitted to make copies of this document for non-commercial purposes only, provided it is not modified when reproduced and appropriate credit is given to CADTH and its licensors.
About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system.
Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
Questions or requests for information about this report can be directed to Requests@CADTH.ca