Sayed Bisma Ali, Posey Drew L, Maskery Brian, Wingate La'Marcus T, Cetron Martin S
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, Building 16, MS 16-4, Atlanta, GA, 30329, USA.
College of Pharmacy, Howard University, Washington, DC, USA.
Pneumonia (Nathan). 2020 Dec 25;12(1):15. doi: 10.1186/s41479-020-00078-z.
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.
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.
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.
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.
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.
虽然获得移民和难民签证的人员在进入美国之前会接受活动性肺结核筛查，但非移民签证申请人（NIVs）通常不接受筛查，可能会携带传染性肺结核进入美国。
我们评估了将出发前肺结核筛查要求扩大到一部分持临时工作签证、来自结核病发病率中等（墨西哥）或高（印度）的国家的非移民签证申请人的成本和效益。
我们开发了一个决策树模型，以评估项目成本，并估计在两种情况下可能在美国诊断出的活动性肺结核病例数：1）“筛查”：在其本国对非移民签证申请人进行肺结核筛查和治疗，并对活动性肺结核风险较高的非移民签证申请人在美国进行推荐的后续跟踪；2）在其本国“不筛查”，以便病例在进入美国后被动诊断并接受治疗。从多个角度评估成本，包括跨国和仅美国的角度。
与“不筛查”相比，在“筛查”情况下，通过出发前治疗，美国每年估计可避免179例活动性肺结核病例和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，从跨国角度来看，筛查项目每避免一例印度非移民签证申请人在美国的病例，成本为151,388美元；每避免一例墨西哥非移民签证申请人在美国的病例，成本为221,088美元。
仅从美国的角度来看，筛查项目将通过降低治疗和住院成本的形式大幅节省成本。非移民签证申请人将产生增加的出发前筛查和治疗成本。
