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Economic analysis of CDC’s culture-based and smear-based tuberculosis instructions for Filipino immigrants
  • Published Date:
    April 01 2018
  • Source:
    Int J Tuberc Lung Dis. 22(4):429-436
  • Language:
    English
Filetype[PDF-326.23 KB]


Details:
  • Pubmed ID:
    29562992
  • Pubmed Central ID:
    PMC6390485
  • Description:
    Setting:

    In 2007, CDC revised its Tuberculosis Technical Instructions for panel physicians who administer mandatory medical examinations of U.S.-bound immigrants. Many U.S.-bound immigrants come from the Philippines, which has high tuberculosis prevalence.

    Objective:

    To quantify economic and health impacts of smear-based versus culture-based tuberculosis screening.

    Design:

    Decision tree modeling compared three Filipino screening programs: (1) ‘No Screening’, (2) ‘Smear-based’, and (3) ‘Culture-based’. The model incorporated pre-departure tuberculosis screening results from Filipino panel physicians and CDC databases with post-arrival follow-up outcomes. Costs (2013 USD) were examined from societal, immigrant, U.S. public health department and hospitalization perspectives.

    Results:

    With ‘No Screening’, an annual cohort of 35,722 Filipino immigrants would include an estimated 450 tuberculosis patients with 264 hospitalizations with societal cost of $9.90 million. ‘Culture-based’ versus ‘Smear-based’ screening would result in fewer imported cases (80.9 vs. 310.5), hospitalizations (19.7 vs. 68.1), and treatment costs ($1.57 million vs. $4.28 million). Societal screening costs including U.S. follow-up were greater for ‘Culture-based” ($5.98 million) than “Smear-based’ ($3.38 million). ‘Culture-based’ requirements increased immigrants’ costs by 61% ($1.7 million), but reduced costs for U.S. public health department (22%, $750,000) and hospitalization (70%, $1,020,000) perspectives.

    Conclusion:

    ‘Culture-based’ screening reduced imported tuberculosis and U.S. costs among Filipino immigrants.

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