Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis.
Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis.
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DOI：
10.1016/s1473-3099(11)70069-x
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发表时间：
2011-06
影响因子：
56.3
通讯作者：
Lalvani, Ajit
中科院分区：
文献类型：
--
作者：
Pareek, Manish;Watson, John P.;Ormerod, L. Peter;Kon, Onn Min;Woltmann, Gerrit;White, Peter J.;Abubakar, Ibrahim;Lalvani, Ajit
英国结核病报告的持续上升可归因于外国出生移民的病例。由于缺乏关于移民中潜伏性肺结核感染流行率和危险因素的数据，对移民筛查的国家指导受到阻碍。我们的目的是确定英国移民中潜伏感染的患病率，以确定哪些人群应该进行筛查，并量化成本效益。在我们的多中心队列研究和成本效益分析中，我们分析了英国三个中心（2008年至2010年）的人口统计和测试结果，这些中心使用干扰素γ释放法（IGRA）筛查35岁或35岁以下移民的潜伏性结核病感染。我们使用逻辑回归评估了与潜伏感染相关的因素，并使用决策分析模型计算了移民原籍国不同结核病发病率水平筛查的收益和成本效益。1229名移民中，igra筛查结果为245例（20%）阳性，982例（80%）阴性，2例（0.2%）不确定。阳性结果与移民原籍国结核病发病率的增加（p= 0.0006）、男性（p= 0.046）和年龄（p< 0.0001）独立相关。到目前为止，国家政策未能检测出71%的潜伏感染者。两项最具成本效益的战略是对来自结核病发病率超过每10万例250例的国家的个人进行筛查（增量成本效益比[ICER]为每预防结核病病例17 956英镑[1英镑= 1.60美元]）和每10万例超过150例（包括来自印度次大陆的移民），其中确定了92%的受感染移民，并以每额外避免病例20 819英镑的成本效益比预防了额外的29例。潜伏感染筛查可以在确定大多数移民患有潜伏性结核病的发病率水平上经济有效地实施，从而预防大量未来的活动性结核病病例。医学研究委员会和威康信托基金
Continuing rises in tuberculosis notifications in the UK are attributable to cases in foreign-born immigrants. National guidance for immigrant screening is hampered by a lack of data about the prevalence of, and risk factors for, latent tuberculosis infection in immigrants. We aimed to determine the prevalence of latent infection in immigrants to the UK to define which groups should be screened and to quantify cost-effectiveness. In our multicentre cohort study and cost-effectiveness analysis we analysed demographic and test results from three centres in the UK (from 2008 to 2010) that used interferon-γ release-assay (IGRA) to screen immigrants aged 35 years or younger for latent tuberculosis infection. We assessed factors associated with latent infection by use of logistic regression and calculated the yields and cost-effectiveness of screening at different levels of tuberculosis incidence in immigrants' countries of origin with a decision analysis model. Results for IGRA-based screening were positive in 245 of 1229 immigrants (20%), negative in 982 (80%), and indeterminate in two (0·2%). Positive results were independently associated with increases in tuberculosis incidence in immigrants' countries of origin (p=0·0006), male sex (p=0·046), and age (p<0·0001). National policy thus far would fail to detect 71% of individuals with latent infection. The two most cost-effective strategies were to screen individuals from countries with a tuberculosis incidence of more than 250 cases per 100 000 (incremental cost-effectiveness ratio [ICER] was £17 956 [£1=US$1·60] per prevented case of tuberculosis) and at more than 150 cases per 100 000 (including immigrants from the Indian subcontinent), which identified 92% of infected immigrants and prevented an additional 29 cases at an ICER of £20 819 per additional case averted. Screening for latent infection can be implemented cost-effectively at a level of incidence that identifies most immigrants with latent tuberculosis, thereby preventing substantial numbers of future cases of active tuberculosis. Medical Research Council and Wellcome Trust.