Cost-effectiveness of tuberculosis infection screening at first reception into English prisons: a model-based analysisResearch in context
Summary: Background: The World Health Organization recommends systematic screening for tuberculosis in incarcerated populations, which are consistently at high risk of tuberculosis relative to the general population. In England, new receptions into prisons do not receive screening for tuberculosis...
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Elsevier
2025-05-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537025001774 |
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| author | Nyashadzaishe Mafirakureva Rachael Hunter Claire F. Ferraro Steve Willner Thomas Finnie Andrew Hayward Andrew Lee Anjana Roy Chantal Edge Peter J. Dodd |
| author_facet | Nyashadzaishe Mafirakureva Rachael Hunter Claire F. Ferraro Steve Willner Thomas Finnie Andrew Hayward Andrew Lee Anjana Roy Chantal Edge Peter J. Dodd |
| author_sort | Nyashadzaishe Mafirakureva |
| collection | DOAJ |
| description | Summary: Background: The World Health Organization recommends systematic screening for tuberculosis in incarcerated populations, which are consistently at high risk of tuberculosis relative to the general population. In England, new receptions into prisons do not receive screening for tuberculosis infection, and evidence from economic evaluations is lacking. Methods: We performed a cost-effectiveness analysis of introducing systematic screening for tuberculosis infection at first reception into English prisons from a health systems perspective. We used a tuberculosis transmission model calibrated to public data on prison populations and flows. We developed decision tree models of prison-specific tuberculosis care pathways and their costs, informed by stakeholders and pilot studies. Sensitivity analyses included eliminating loss to follow-up (LTFU) in care cascades, zeroing extramural escort costs, and targeting screening to those born in countries with higher tuberculosis incidence (over 40 per 100,000 per year). Findings: In our base case analysis, the intervention had an incremental cost-effectiveness ratio (ICER) of £78,000 per quality-adjusted life-year (QALY) gained. Reducing LTFU and avoiding prison escort costs would substantially improve cost-effectiveness, to ICERs of £70,000 and £54,000 per QALY gained, respectively. Targeting those born in higher incidence countries was predicted to be cost-saving. Interpretation: Universal tuberculosis screening and preventive treatment for new receptions into English prisons is not cost-effective by the usual threshold of £30,000. However, targeting high-risk groups could be cost-saving. Tuberculosis interventions should explore ways to reduce LTFU and extramural healthcare in order to meet the needs of those incarcerated while minimizing costs. Funding: UKHSA from 9/2023 to 12/2024. |
| format | Article |
| id | doaj-art-c0c9b2fbfd1a4e9b8860ccca1c4b3a80 |
| institution | DOAJ |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-c0c9b2fbfd1a4e9b8860ccca1c4b3a802025-08-20T02:58:25ZengElsevierEClinicalMedicine2589-53702025-05-018310324510.1016/j.eclinm.2025.103245Cost-effectiveness of tuberculosis infection screening at first reception into English prisons: a model-based analysisResearch in contextNyashadzaishe Mafirakureva0Rachael Hunter1Claire F. Ferraro2Steve Willner3Thomas Finnie4Andrew Hayward5Andrew Lee6Anjana Roy7Chantal Edge8Peter J. Dodd9Sheffield Centre for Health and Related Research (SCHARR), School of Medicine & Population Health, University of Sheffield, UKThe Research Department of Primary Care and Population Health, University College London, London, UKHealth Equity and Inclusion Health Division, UK Health Security Agency, London, UK; National Public Health Speciality Training Programme, South West, Bristol, UKHealth Equity and Inclusion Health Division, UK Health Security Agency, London, UKModelling and Data-Science for Emergency Preparedness, Resilience, and Response, UK Health Security Agency, Porton Down, UKHealth Equity and Inclusion Health Division, UK Health Security Agency, London, UK; Institute of Epidemiology and Health Care, University College London, London, UKSheffield Centre for Health and Related Research (SCHARR), School of Medicine & Population Health, University of Sheffield, UK; Health Protection Division, UK Health Security Agency, Leeds, UKHealth Equity and Inclusion Health Division, UK Health Security Agency, London, UKHealth Equity and Inclusion Health Division, UK Health Security Agency, London, UKSheffield Centre for Health and Related Research (SCHARR), School of Medicine & Population Health, University of Sheffield, UK; Corresponding author. Sheffield Centre for Health and Related Research (SCHARR), School of Medicine & Population Health, University of Sheffield, 30 Regent St, Sheffield, S14DA, UK.Summary: Background: The World Health Organization recommends systematic screening for tuberculosis in incarcerated populations, which are consistently at high risk of tuberculosis relative to the general population. In England, new receptions into prisons do not receive screening for tuberculosis infection, and evidence from economic evaluations is lacking. Methods: We performed a cost-effectiveness analysis of introducing systematic screening for tuberculosis infection at first reception into English prisons from a health systems perspective. We used a tuberculosis transmission model calibrated to public data on prison populations and flows. We developed decision tree models of prison-specific tuberculosis care pathways and their costs, informed by stakeholders and pilot studies. Sensitivity analyses included eliminating loss to follow-up (LTFU) in care cascades, zeroing extramural escort costs, and targeting screening to those born in countries with higher tuberculosis incidence (over 40 per 100,000 per year). Findings: In our base case analysis, the intervention had an incremental cost-effectiveness ratio (ICER) of £78,000 per quality-adjusted life-year (QALY) gained. Reducing LTFU and avoiding prison escort costs would substantially improve cost-effectiveness, to ICERs of £70,000 and £54,000 per QALY gained, respectively. Targeting those born in higher incidence countries was predicted to be cost-saving. Interpretation: Universal tuberculosis screening and preventive treatment for new receptions into English prisons is not cost-effective by the usual threshold of £30,000. However, targeting high-risk groups could be cost-saving. Tuberculosis interventions should explore ways to reduce LTFU and extramural healthcare in order to meet the needs of those incarcerated while minimizing costs. Funding: UKHSA from 9/2023 to 12/2024.http://www.sciencedirect.com/science/article/pii/S2589537025001774TBTuberculosis preventive therapyTPTPersons deprived of libertyEconomic evaluationCost-utility analysis |
| spellingShingle | Nyashadzaishe Mafirakureva Rachael Hunter Claire F. Ferraro Steve Willner Thomas Finnie Andrew Hayward Andrew Lee Anjana Roy Chantal Edge Peter J. Dodd Cost-effectiveness of tuberculosis infection screening at first reception into English prisons: a model-based analysisResearch in context EClinicalMedicine TB Tuberculosis preventive therapy TPT Persons deprived of liberty Economic evaluation Cost-utility analysis |
| title | Cost-effectiveness of tuberculosis infection screening at first reception into English prisons: a model-based analysisResearch in context |
| title_full | Cost-effectiveness of tuberculosis infection screening at first reception into English prisons: a model-based analysisResearch in context |
| title_fullStr | Cost-effectiveness of tuberculosis infection screening at first reception into English prisons: a model-based analysisResearch in context |
| title_full_unstemmed | Cost-effectiveness of tuberculosis infection screening at first reception into English prisons: a model-based analysisResearch in context |
| title_short | Cost-effectiveness of tuberculosis infection screening at first reception into English prisons: a model-based analysisResearch in context |
| title_sort | cost effectiveness of tuberculosis infection screening at first reception into english prisons a model based analysisresearch in context |
| topic | TB Tuberculosis preventive therapy TPT Persons deprived of liberty Economic evaluation Cost-utility analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025001774 |
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