Risks and consequences of TB and its prevention in cost-utility analyses among immigrants: a systematic review

In low-TB incidence countries, foreign-born populations bear a disproportionate share of the TB burden. Cost-utility analyses of TB preventive treatment (TPT) programs among immigrants, however, have yielded divergent conclusions. We conducted a systematic review to evaluate how studies have considered the risks and consequences of TB disease and TPT.

We searched PubMed and Embase for studies published from 1^st January 2004 to 25^th March 2025. We included modeling studies measuring health utility with quality-adjusted life years (QALYs) and evaluated TPT among immigrants to low TB incidence countries. Using a narrative synthesis, we examined how studies considered risks and consequences of TB disease and TPT and their impacts on health utility.

Of the 5,142 records screened, 14 studies met the inclusion criteria. Major adverse events (AEs) were the most frequently considered consequence of TPT with estimated risk ranging from 0% to 6% and mean associated annual disutility from major AEs was 0.017 QALYs, which varied substantially (coefficient of variation [CV)]: 1.2). All studies considered health disutility due to TB disease, with annual disutility ranging from 0.04 to 0.2 (mean: 0.11, CV: 0.4).

There is wide variation in how risks and consequences of TPT and TB disease are considered in studies evaluating TB infection treatment programs.