Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas.

IF 8.5 Q1 RESPIRATORY SYSTEM
Bisma Ali Sayed, Drew L Posey, Brian Maskery, La'Marcus T Wingate, Martin S Cetron
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引用次数: 0

Abstract

Background: While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis.

Objectives: We evaluated the costs and benefits of expanding pre-departure tuberculosis screening requirements to a subset of NIVs who arrive from a moderate (Mexico) or high (India) incidence tuberculosis country with temporary work visas.

Methods: We developed a decision tree model to evaluate the program costs and estimate the numbers of active tuberculosis cases that may be diagnosed in the United States in two scenarios: 1) "Screening": screening and treatment for tuberculosis among NIVs in their home country with recommended U.S. follow-up for NIVs at elevated risk of active tuberculosis; and, 2) "No Screening" in their home country so that cases would be diagnosed passively and treatment occurs after entry into the United States. Costs were assessed from multiple perspectives, including multinational and U.S.-only perspectives.

Results: Under "Screening" versus "No Screening", an estimated 179 active tuberculosis cases and 119 hospitalizations would be averted in the United States annually via predeparture treatment. From the U.S.-only perspective, this program would result in annual net cost savings of about $3.75 million. However, rom the multinational perspective, the screening program would cost $151,388 per U.S. case averted for Indian NIVs and $221,088 per U.S. case averted for Mexican NIVs.

Conclusion: From the U.S.-only perspective, the screening program would result in substantial cost savings in the form of reduced treatment and hospitalization costs. NIVs would incur increased pre-departure screening and treatment costs.

Abstract Image

Abstract Image

在非移民美国工作签证申请人中实施结核病筛查的成本效益分析。
背景:虽然获得移民和难民签证的人在进入美国之前要进行活动性结核病筛查,但非移民签证申请人(niv)不进行常规筛查,可能携带传染性结核病进入美国。目的:我们评估了将出境前结核病筛查要求扩大到从结核病中等发病率(墨西哥)或高发病率(印度)国家持临时工作签证抵达的部分niv的成本和收益。方法:我们开发了一个决策树模型来评估项目成本,并估计在两种情况下美国可能被诊断出的活动性结核病病例的数量:1)“筛查”:在本国的niv中进行结核病筛查和治疗,并推荐美国对活动性结核病高风险的niv进行随访;, 2)在其本国“无筛查”,以便被动诊断病例,并在进入美国后进行治疗。成本从多个角度进行评估,包括跨国公司和美国的角度。结果:在“筛查”与“未筛查”的对比中,美国估计每年通过出发前治疗可避免179例活动性结核病病例和119例住院治疗。仅从美国的角度来看,该项目每年将节省约375万美元的净成本。然而,从多国的角度来看,筛查计划将花费151,388美元,为印度niv避免每个美国病例,为墨西哥niv避免每个美国病例221,088美元。结论:仅从美国的角度来看,筛查计划将以减少治疗和住院费用的形式节省大量成本。niv会增加出发前的筛查和治疗费用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pneumonia
Pneumonia RESPIRATORY SYSTEM-
自引率
1.50%
发文量
7
审稿时长
11 weeks
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