The Role of Tuberculosis Screening Among Migrants to Low-Incidence Settings in (Not) Achieving Elimination.

Abstract

The cost-effectiveness of migrant tuberculosis prevention programs is highly relevant to many low tuberculosis incidence countries as they attempt to eliminate the disease. Dale and colleagues (Am J Epidemiol 2021;XX(XX):XX) evaluated strategies for tuberculosis infection screening and treatment among new migrants to Australia. Screening for infection before migration, then administering preventive treatment after arrival, was more cost-effective than performing both screening and treatment after arrival. From the Australian health payer perspective, the improved cost-effectiveness of pre-migration screening partly reflected the shift of screening costs to migrants, which may raise ethical concerns. Key sensitivity analyses highlighted the influence of health disutility associated with tuberculosis preventive treatment, and of post-treatment sequelae of tuberculosis disease. Both considerations warrant greater attention in future research. For all strategies, the impact on tuberculosis incidence among migrants was modest (<15%), suggesting enhanced migrant screening will not achieve tuberculosis elimination in low-incidence settings. This emphasizes the need to increase investment and effort in global tuberculosis prevention and care, which will ultimately reduce the prevalence of tuberculosis infection and therefore the risk of tuberculosis disease among migrants. Such efforts will benefit high and low tuberculosis incidence countries alike, and advance all countries further toward tuberculosis elimination.