RT Journal Article
SR Electronic
T1 Active screening for tuberculosis in high-incidence Inuit communities in Canada: a cost-effectiveness analysis
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1652
OP E1659
DO 10.1503/cmaj.210447
VO 193
IS 43
A1 Uppal, Aashna
A1 Nsengiyumva, Ntwali Placide
A1 Signor, Céline
A1 Jean-Louis, Frantz
A1 Rochette, Marie
A1 Snowball, Hilda
A1 Etok, Sandra
A1 Annanack, David
A1 Ikey, Julie
A1 Khan, Faiz Ahmad
A1 Schwartzman, Kevin
YR 2021
UL http://www.cmaj.ca/content/193/43/E1652.abstract
AB Background: Active screening for tuberculosis (TB) involves systematic detection of previously undiagnosed TB disease or latent TB infection (LTBI). It may be an important step toward elimination of TB among Inuit in Canada. We aimed to evaluate the cost-effectiveness of community-wide active screening for TB infection and disease in 2 Inuit communities in Nunavik.Methods: We incorporated screening data from the 2 communities into a decision analysis model. We predicted TB-related health outcomes over a 20-year time frame, beginning in 2019. We assessed the cost-effectiveness of active screening in the presence of varying outbreak frequency and intensity. We also considered scenarios involving variation in timing, impact and uptake of screening programs.Results: Given a single large outbreak in 2019, we estimated that 1 round of active screening reduced TB disease by 13% (95% uncertainty range −3% to 27%) and was cost saving compared with no screening, over 20 years. In the presence of simulated large outbreaks every 3 years thereafter, a single round of active screening was cost saving, as was biennial active screening. Compared with a single round, we also determined that biennial active screening reduced TB disease by 59% (95% uncertainty range 52% to 63%) and was estimated to cost Can$6430 (95% uncertainty range −$29 131 to $13 658 in 2019 Can$) per additional active TB case prevented. With smaller outbreaks or improved rates of treatment initiation and completion for people with LTBI, we determined that biennial active screening remained reasonably cost-effective compared with no active screening.Interpretation: Active screening is a potentially cost-saving approach to reducing disease burden in Inuit communities that have frequent TB outbreaks.