Improving the tuberculosis infection care cascade among migrants in Canada: a cost-effectiveness modelling study

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Services Research

Background:

• Tuberculosis elimination necessitates expanded preventive treatment, yet adherence challenges persist, particularly among vulnerable migrant populations.
• Current tuberculosis care cascades face adherence issues, highlighting the need for improved strategies in migrant health.
• Migrants represent a key demographic affected by tuberculosis, requiring targeted public health interventions.

Purpose of the Study:

• To assess a person-centered approach to tuberculosis screening and treatment among new migrants in Canada.
• To compare the effectiveness and cost-effectiveness of tuberculosis prevention strategies with and without facilitators.
• To evaluate the impact of facilitators on tuberculosis infection cascade of care adherence in migrant populations.

Main Methods:

• A Markov model simulated a cohort of 100,000 adult migrants from high-incidence tuberculosis countries over a 20-year horizon.
• The model estimated costs, tuberculosis episodes, and quality-adjusted life-years (QALYs) for status quo versus facilitated screening and treatment.
• Facilitators included interpreters, peer navigators, educational materials, and text message reminders.

Main Results:

• Facilitated screening strategies averted more tuberculosis episodes and deaths, yielding greater QALY gains compared to non-facilitated strategies.
• While facilitated strategies incurred higher initial costs, they demonstrated lower costs per tuberculosis episode averted and QALY gained.
• Expanded screening with facilitators prevented 375 tuberculosis cases and 17 deaths per 100,000 migrants, with an incremental cost of $53,050 per episode averted.

Conclusions:

• Person-centered facilitators, including interpreters and peer navigators, enhance the effectiveness and cost-effectiveness of tuberculosis screening and treatment for migrants.
• Integrating facilitators into future tuberculosis prevention strategies is recommended to improve outcomes in migrant populations.
• Text message reminders and educational materials are valuable components of facilitated tuberculosis prevention programs.