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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:
Filetype[PDF-326.23 KB]

  • Alternative Title:
    Int J Tuberc Lung Dis
  • Description:

    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.


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


    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.


    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.


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

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