Is LTBI screening cost effective in high-risk populations?

Introduction: In lower tuberculosis (TB) incidence countries (<100 cases/100,000/year), screening and preventive treatment (PT) for latent TB infection (LTBI) among people living with HIV (PLWH) is often recommended, yet guidelines advising which groups to prioritise for screening can be contradictory and implementation patchy. Evidence of LTBI screening cost-effectiveness may improve uptake and health outcomes at reasonable cost. Methods: Our systematic review assessed cost-effectiveness estimates of LTBI screening/PT strategies among PLWH in lower TB incidence countries to identify model-driving inputs and methodological differences. Databases were searched 1980-2020. Studies including health economic evaluation of LTBI screening of PLWH in lower TB incidence countries (<100 cases/100,000/year) were included. Study quality was assessed using the CHEERS checklist. Results: Of 2,644 articles screened, nine studies were included. Cost-effectiveness estimates of LTBI screening/PT for PLWH varied widely, with universal screening/PT found highly cost-effective by some studies, while only targeting to high-risk groups (such as those from mid/high TB incidence countries) deemed cost-effective by others. Cost-effectiveness of strategies screening all PLWH from studies published in the past five years varied from US$2828 to US$144,929/quality-adjusted life-year gained (2018 prices). Study quality varied, with inconsistent reporting of methods and results limiting comparability of studies. Cost-effectiveness varied markedly by screening guideline, with British HIV Association guidelines more cost-effective than NICE guidelines in the UK. Discussion: Cost-effectiveness studies of LTBI screening/PT for PLWH in lower TB incidence settings are scarce, with large variations in methods and assumptions used, target populations and screening/PT strategies evaluated. The limited evidence suggests LTBI screening/PT may be cost-effective for some PLWH groups but further research is required, particularly on strategies targeting screening/PT to PLWH at higher risk. Standardisation of model descriptions and results reporting could facilitate reliable comparisons between studies, particularly to identify those factors driving the wide disparity between cost-effectiveness estimates. Registration: PROSPERO CRD42020166338 (18/03/2020).

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Natriuretic Peptides~: Prediction of Cardiovascular Disease in the General Population and High Risk Populations

Disease Markers ◽

10.1155/2009/837256 ◽

2009 ◽

Vol 26 (5-6) ◽

pp. 227-233 ◽

Cited By ~ 8

Author(s):

Per Hildebrandt

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Natriuretic Peptides ◽

Systolic Function ◽

Cost Effective ◽

Patients With Diabetes ◽

High Risk Populations ◽

Artery Disease

The natriuretic peptides, especially the B-type peptide (BNP) and its inactive split-product N-terminal proBNP (Nt-proBNP) are increasingly used in screening for heart failure, primarily with reduced systolic function, in patients with symptoms suggestive of heart failure, as well in the stable (General Practitioner) setting as in the acute setting.Supporting this use is a very strong prognostic value of the natriuretic peptides. This has been shown in as well heart failure as acute coronary syndromes, but also in the general population and in high-risk groups as patients with diabetes, hypertension and coronary artery disease.This has of course raised interest for the use of the natriuretic peptides as a risk marker and for screening for heart failure with reduced systolic function in these populations. In symptomatic persons and in high risk populations, the natriuretic peptides have demonstrated a high sensitivity for ruling out the disease, if the right decision limits are choosen. Thus the number of normal echocardiographies can be reduced.More recently, the use in screening asymptomatic persons for left ventricular systolic dysfunction has gained more interest. In the unselected population, screening would probably not be cost-effective. In populations with a higher pre-test probability for heart failure, as patients with diabetes, hypertension and stable coronary artery disease, screening would presumably be more cost-effective, but evidence for the use in this setting is still lacking.

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Is the universal population Hepatitis C virus screening a cost-effective strategy? A systematic review of the economic evidence

Revista Española de Quimioterapia ◽

10.37201/req/030.2020 ◽

2020 ◽

Vol 33 (4) ◽

pp. 240-248

Author(s):

Francisco Ledesma ◽

María Buti ◽

Raquel Domínguez-Hernández ◽

Miguel Ángel Casado ◽

Rafael Esteban

Keyword(s):

Systematic Review ◽

Hepatitis C Virus ◽

Hepatitis C ◽

High Risk ◽

General Population ◽

Cost Effective ◽

Population Screening ◽

Economic Evaluations ◽

Inclusion Criteria ◽

High Risk Populations

Background. Efficient strategies are needed in order to achieve the objective of the WHO of eradicating Hepatitis C virus (HCV). Hepatitis C infection can be eliminated by a combination of direct acting antiviral (DAA). The problem is that many individuals remain undiagnosed. The objective is to conduct a systematic review of the evidence on economic evaluations that analyze the screening of HCV followed by treatment with DAAs. Methods. Eleven databases were performed in a 2015-2018-systematic review. Inclusion criteria were economic evaluations that included incremental cost-effectiveness ratio (ICER) in terms of cost per life year gained or quality-adjusted life year. Results. A total of 843 references were screened. Sixteen papers/posters meet the inclusion criteria. Ten of them included a general population screening. Other populations included were baby-boomer, people who inject drugs, prisoners or immigrants. Comparator was “standard of care”, other high-risk populations or no-screening. Most of the studies are based on Markov model simulations and they mostly adopted a healthcare payer´s perspective. ICER for general population screening plus treatment versus high-risk populations or versus routinely performed screening showed to be below the accepted willingness to pay thresholds in most studies and therefore screening plus DAAs strategy is highly cost-effective. Conclusion. This systematic review shows that screening programmes followed by DAAs treatment is cost-effective not only for high risk population but for general population too. Because today HCV can be easily cured and its long-term consequences avoided, a universal HCV screening plus DAAs therapies should be the recommended strategy to achieve the WHO objectives for HCV eradication by 2030.

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Pre-Diabetes Detection and Intervention for High Risk Communities

Journal of Physical Activity and Health ◽

10.1123/jpah.7.s3.s327 ◽

2010 ◽

Vol 7 (s3) ◽

pp. S327-S340

Author(s):

Jennifer L Kuk ◽

Shahnaz Davachi ◽

Andrea M. Kriska ◽

Michael C. Riddell ◽

Edward W. Gregg

Keyword(s):

High Risk ◽

Physical Activity Intervention ◽

Healthy Lifestyle ◽

Cost Effective ◽

Intervention Delivery ◽

Effective Manner ◽

Prevention Interventions ◽

High Risk Populations ◽

Risk Communities ◽

Health Care Centers

This article briefly summarizes the “Pre-Diabetes Detection and Intervention Symposium” that described ongoing and past pre-diabetes interventions, and outlined some considerations when deciding to target specific populations with pre-diabetes. The success of type 2 diabetes (T2D) prevention clinical trials provides clear evidence that healthy lifestyle change can prevent the development of T2D in a cost effective manner in high risk individuals. However, who to target and what cut-points should be used to identify individuals who would qualify for these T2D prevention programs are not simple questions. More stringent cut-offs are more efficient in preventing T2D, but less equitable. Interventions will likely need to be adapted and made more economical for local communities and health care centers if they are to be adopted universally. Further, they may need to be adapted to meet the specific needs of certain high-risk populations such as ethnic minorities. The Chronic Disease Management & Prevention Program for Diverse Populations in Alberta and the Pre-diabetes Detection and Physical Activity Intervention Delivery project in Toronto represent 2 examples of specialized interventions that are targeted at certain high risk populations. To reverse the current T2D trends will require continued efforts to develop and refine T2D prevention interventions.

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A screening strategy for latent tuberculosis in healthcare workers: Cost-effectiveness and budget impact of universal versus targeted screening

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.334 ◽

2019 ◽

Vol 40 (3) ◽

pp. 341-349

Author(s):

May Ee Png ◽

Joanne Yoong ◽

Catherine Wei Min Ong ◽

Dale Fisher ◽

Natasha Bagdasarian

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

Universal Screening ◽

Healthcare Workers ◽

Current Practice ◽

Budget Impact ◽

Latent Tuberculosis ◽

Cost Effective ◽

Ltbi Screening ◽

Screening Strategies

AbstractObjective:To evaluate the clinical, cost-efficiency, and budgetary implications of universal versus targeted latent tuberculosis infection (LTBI) screening strategies among healthcare workers (HCWs) in an intermediate tuberculosis (TB)-burden country.Design:Pragmatic cost-effectiveness and budget impact analysis using decision-analytic modeling.Setting:A tertiary-care hospital in Singapore.Methods:We compared 7 potentially implementable LTBI screening programs including universal and targeted strategies with different screening frequencies. Feasible targeting methods included stratification by country of origin (a proxy for risk of prior TB exposure) and by high-risk occupation. The clinical and financial consequences of each strategy were estimated relative to “no screening” (current practice) and compared to locally appropriate cost-effectiveness thresholds. All analyses were conducted from the hospital’s perspective over a 3-year time horizon, based on the typical hospital planning period. Parameter uncertainties were accounted for using sensitivity analyses.Results:In our model, relative to current practice, screening new international hires and triennial screening of existing high-risk workers is most cost-effective (US$58 per quality adjusted life year [QALY]) and decreases active TB cases from 19 to 14. Screening all new hires combined with triennial universal screening, with or without annual high-risk screening or annual universal screening, reduced active TB to a range of 19 to 6 cases, but these strategies are less cost-effective and require substantially higher expenditures.Conclusions: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.

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