Hontelez Jan A C, Spruijt Ineke T, Bakker Roel, Cobelens Frank, Erkens Connie, van den Hof Susan, de Vlas Sake J
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; KNCV Tuberculosis Foundation, The Hague, the Netherlands.
J Infect Public Health. 2025 Oct;18(10):102889. doi: 10.1016/j.jiph.2025.102889. Epub 2025 Jul 7.
We evaluated the cost-effectiveness of TB infection (TBI) screening and TB preventive treatment (TPT) for immigrants, asylum seekers, and settled migrants in The Netherlands.
We used a deterministic cohort model that captures the natural history of TBI and TB disease for a migrant cohort in the country of origin (pre-entry) and in The Netherlands (post-entry). We fitted the pre-entry force of infection to Interferon Gamma Release Assay (IGRA) positivity rates from an implementation pilot study, and chest X-ray (CXR) positivity from the national entry-screening programme. We compared the costs per quality adjusted life year (QALY) gained for TBI screening with CXR screening over a 20-year time-horizon, accounting for parameter uncertainty by producing predictions for over 1000 unique parameter combinations that fit the data.
TBI screening uniformly resulted in an increase in QALYs gained compared to current CXR-based screening policies. For immigrants, <10 % of parameter combinations predicted TBI entry screening to be more cost-effective than CXR screening under observed TPT completion rates (36 %). However, this changed to nearly 100 % of parameter combinations for immigrants coming from countries with a TB incidence of ≥100 per 100,000 when applying TPT completion rates as observed in asylum seekers (72 %). For asylum seekers, 100 % of parameter combinations predicted cost-effectiveness, while 0 % predicted TBI screening to be cost-effective among settled migrants.
TBI entry screening is a cost-effective alternative to CXR entry screening for immigrants and asylum seekers coming from high TB endemic countries, provided TPT completion is sufficiently high.
我们评估了荷兰针对移民、寻求庇护者和定居移民进行结核病感染（TBI）筛查及结核病预防性治疗（TPT）的成本效益。
我们使用了一个确定性队列模型，该模型描述了移民队列在原籍国（入境前）和荷兰（入境后）TBI和结核病的自然病程。我们将入境前的感染率与一项实施试点研究中的干扰素γ释放试验（IGRA）阳性率以及国家入境筛查计划中的胸部X光（CXR）阳性率进行拟合。我们比较了在20年时间范围内，TBI筛查与CXR筛查每获得一个质量调整生命年（QALY）的成本，并通过对1000多个符合数据的独特参数组合进行预测来考虑参数不确定性。
与当前基于CXR的筛查政策相比，TBI筛查始终会使获得的QALY增加。对于移民，在观察到的TPT完成率（36%）下，<10%的参数组合预测TBI入境筛查比CXR筛查更具成本效益。然而，当应用在寻求庇护者中观察到的TPT完成率（72%）时，对于来自结核病发病率≥100/10万国家的移民，这一比例变为近100%。对于寻求庇护者，100%的参数组合预测具有成本效益，而对于定居移民，0%的参数组合预测TBI筛查具有成本效益。
对于来自结核病高流行国家的移民和寻求庇护者，只要TPT完成率足够高，TBI入境筛查是CXR入境筛查的一种具有成本效益的替代方法。
