title: A Systematic Review of Studies Evaluating the Cost Utility of Screening High-Risk Populations for Latent Tuberculosis Infection.
abstract: BACKGROUND
  As tuberculosis screening trends to targeting high-risk populations, knowing the cost effectiveness of such screening is vital to decision makers.
  
  
  OBJECTIVE
  The purpose of this review was to compile cost-utility analyses evaluating latent tuberculosis infection (LTBI) screening in high-risk populations that used quality-adjusted life-years (QALYs) as their measure of effectiveness.
  
  
  METHODS
  A literature search of MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Web of Knowledge, and PubMed was performed from database start to November 2014.
  
  
  METHODS
  Studies performed in populations at high risk of LTBI and subsequent reactivation that used the QALY as an effectiveness measure were included.
  
  
  METHODS
  Quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Data extracted included tuberculin skin test (TST) and/or interferon-gamma release assay (IGRA) use, economic, screening, treatment, health state, and epidemiologic parameters. Data were summarized in regard to consistency in model parameters and the incremental cost-effectiveness ratio (ICER), with costs adjusted to 2013 US dollars.
  
  
  RESULTS
  Of 415 studies identified, ultimately eight studies were included in the review. Most took a societal perspective (n = 4), used lifetime time horizons (n = 6), and used Markov models (n = 8). Screening of adult immigrants was found to be cost effective with a TST in one study, but moderately cost effective with an IGRA in another study; screening immigrants arriving more than 5 years prior with an IGRA was moderately cost effective until 44 years of age (n = 1). Screening HIV-positive patients was highly cost effective with a TST (n = 1) and moderately cost effective with an IGRA (n = 1). Screening in those with renal diseases (n = 2) and diabetes (n = 1) was not cost effective.
  
  
  CONCLUSIONS
  Very few studies used the QALY as their effectiveness measure. Parameter and study design inconsistencies limit the comparability of studies.
  
  
  CONCLUSIONS
  With validity issues in terms of parameters and assumptions, any conclusion should be interpreted with caution. Despite this, some cautionary recommendations emerged: screening HIV patients with a TST is highly cost effective, while screening adult immigrants with an IGRA is moderately cost effective.
authors.affiliation: University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
authors.forename: Jonathon R
authors.initials: JR
authors.lastname: Campbell
authors.forename: Thenuga
authors.initials: T
authors.lastname: Sasitharan
authors.forename: Fawziah
authors.initials: F
authors.lastname: Marra
mesh_terms: D000328:Adult; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D016206:Databases, Bibliographic; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D016867:Immunocompromised Host; D007674:Kidney Diseases / Q000191:economics / Q000453:epidemiology; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics* / Q000379:methods / Q000592:standards; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment