Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Economics

Background:

• Nonimmigrant visa applicants (NIVs) are not routinely screened for active tuberculosis (TB) before U.S. entry, unlike immigrant and refugee visa holders.
• This gap allows individuals with infectious TB to enter the United States, posing a public health risk.

Purpose of the Study:

• To evaluate the cost-effectiveness of implementing pre-departure TB screening for NIVs from moderate (Mexico) and high (India) incidence countries.
• To estimate the number of active TB cases and hospitalizations averted in the U.S. through expanded screening.

Main Methods:

• A decision tree model was developed to compare two scenarios: pre-departure screening and treatment versus no pre-departure screening.
• Costs were analyzed from both multinational and U.S.-only perspectives.
• The model estimated active TB cases diagnosed and hospitalizations in the U.S. under each scenario.

Main Results:

• Pre-departure screening could avert approximately 179 active TB cases and 119 hospitalizations annually in the U.S.
• From a U.S.-only perspective, the screening program is projected to yield net cost savings of about $3.75 million annually.
• However, from a multinational perspective, the program incurs costs of $151,388 per U.S. case averted for Indian NIVs and $221,088 for Mexican NIVs.

Conclusions:

• Implementing pre-departure TB screening for NIVs from high-incidence countries results in substantial cost savings from a U.S.-only viewpoint due to reduced treatment and hospitalization expenses.
• NIVs would face increased costs for pre-departure screening and treatment.
• The study highlights a trade-off between U.S. domestic cost savings and international program expenditures.