Risks and consequences of TB and its prevention in cost-utility analyses among immigrants: a systematic review.

Background: In low-TB incidence countries, foreign-born populations bear a disproportionate share of the TB burden. Cost-utility analyses of TB preventive treatment (TPT) programs among immigrants, however, have yielded divergent conclusions. We conducted a systematic review to evaluate how studies have considered the risks and consequences of TB disease and TPT.

Methods: We searched PubMed and Embase for studies published from 1^st January 2004 to 25^th March 2025. We included modeling studies measuring health utility with quality-adjusted life years (QALYs) and evaluated TPT among immigrants to low TB incidence countries. Using a narrative synthesis, we examined how studies considered risks and consequences of TB disease and TPT and their impacts on health utility.

Results: Of the 5,142 records screened, 14 studies met the inclusion criteria. Major adverse events (AEs) were the most frequently considered consequence of TPT with estimated risk ranging from 0% to 6% and mean associated annual disutility from major AEs was 0.017 QALYs, which varied substantially (coefficient of variation [CV)]: 1.2). All studies considered health disutility due to TB disease, with annual disutility ranging from 0.04 to 0.2 (mean: 0.11, CV: 0.4).

Conclusions: There is wide variation in how risks and consequences of TPT and TB disease are considered in studies evaluating TB infection treatment programs.