title: Cost-effectiveness of screening for active cases of tuberculosis in Flanders, Belgium.
abstract: OBJECTIVE
  To assess the cost-effectiveness of the tuberculosis screening activities currently funded by the Flemish government in Flanders, Belgium.
  
  
  METHODS
  After estimating the expenses for 2013-2014 of each of nine screening components - which include high-risk groups, contacts and people who are seeking tuberculosis consultation at a centre for respiratory health care - and the associated costs per active case of tuberculosis identified between 2007 and 2014, we compared the cost-effectiveness of each component. The applied perspective was that of the Flemish government.
  
  
  RESULTS
  The three most cost-effective activities appeared to be the follow-up of asylum seekers who were found to have abnormal X-rays in initial screening at the Immigration Office, systematic screening in prisons and contact investigation. The mean costs of these activities were 5564 (95% uncertainty interval, UI: 3791-8160), 11 603 (95% UI: 9010-14 909) and 13 941 (95% UI: 10 723-18 201) euros (€) per detected active case, respectively. The periodic or supplementary initial screening of asylum seekers and the screening of new immigrants from high-incidence countries - which had corresponding costs of €51 813 (95% UI: 34 855-76 847), €126 236 (95% UI: 41 984-347 822) and €418 359 (95% UI: 74 975-1 686 588) - appeared much less cost-effective. Between 2007 and 2014, no active tuberculosis cases were detected during screening in the juvenile detention centres.
  
  
  CONCLUSIONS
  In Flanders, tuberculosis screening in juvenile detention centres and among new immigrants and the periodic or supplementary initial screening of asylum seekers appear to be relatively expensive ways of detecting people with active tuberculosis.
authors.affiliation: Department of Virology, Parasitology and Immunology, Ghent University, Ghent, Belgium .
authors.forename: G Suzanne A
authors.initials: GS
authors.lastname: Smit
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium .
authors.forename: Ludwig
authors.initials: L
authors.lastname: Apers
authors.affiliation: Flemish Association for Respiratory Health and Tuberculosis Control, Brussels, Belgium .
authors.forename: Wouter
authors.initials: W
authors.lastname: Arrazola de Onate
authors.affiliation: Centre for Health Economics Research & Modelling Infectious Diseases, University of Antwerp, Antwerp, Belgium .
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium .
authors.forename: Pierre
authors.initials: P
authors.lastname: Dorny
authors.affiliation: Agency for Care and Health, Government of Flanders, Brussels, Belgium .
authors.forename: An-Marie
authors.initials: AM
authors.lastname: Forier
authors.affiliation: Flemish Association for Respiratory Health and Tuberculosis Control, Brussels, Belgium .
authors.forename: Kristien
authors.initials: K
authors.lastname: Janssens
authors.affiliation: Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium .
authors.forename: Jean
authors.initials: J
authors.lastname: Macq
authors.affiliation: Agency for Care and Health, Government of Flanders, Brussels, Belgium .
authors.forename: Ruud
authors.initials: R
authors.lastname: Mak
authors.affiliation: Flemish Association for Respiratory Health and Tuberculosis Control, Brussels, Belgium .
authors.forename: Sandrina
authors.initials: S
authors.lastname: Schol
authors.affiliation: Agency for Care and Health, Government of Flanders, Brussels, Belgium .
authors.forename: Dirk
authors.initials: D
authors.lastname: Wildemeersch
authors.affiliation: Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium .
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
authors.affiliation: Scientific Institute of Public Health (WIV-ISP), Department of Public Health and Surveillance, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium .
authors.forename: Brecht
authors.initials: B
authors.lastname: Devleesschauwer
mesh_terms: D001530:Belgium / Q000453:epidemiology; D016358:Contact Tracing / Q000191:economics*; D003362:Cost-Benefit Analysis; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration*; D011329:Prisoners; D012036:Refugees; D012307:Risk Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D000069756:Undocumented Immigrants