Comparison of active tuberculosis case finding strategies for immigrants in South Korea: Epidemiology and cost-effectiveness analysis

Sangwook Park; Chaegyu Sung; Hangseok Choi; Yeo Wool Lee; Yedham Kang; Hee-Jin Kim; Hae-Young Kim; In-Hwan Oh; Seung Heon Lee

doi:10.1371/journal.pone.0283414

Comparison of active tuberculosis case finding strategies for immigrants in South Korea: Epidemiology and cost-effectiveness analysis

PLoS One. 2023 Apr 20;18(4):e0283414. doi: 10.1371/journal.pone.0283414. eCollection 2023.

Authors

Sangwook Park¹, Chaegyu Sung¹, Hangseok Choi², Yeo Wool Lee³, Yedham Kang⁴, Hee-Jin Kim⁵, Hae-Young Kim⁶, In-Hwan Oh⁷, Seung Heon Lee⁴

Affiliations

¹ Korea University College of Medicine, Seoul, South Korea.
² Medical Science Research Center, Korea University Ansan Hospital, Ansan, South Korea.
³ Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.
⁴ Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea.
⁵ Central Education Institution, KoreanNational Tuberculosis Association, Seoul, South Korea.
⁶ Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America.
⁷ Department of Preventive Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.

Abstract

Background: Tuberculosis (TB) is one of the serious infectious diseases in South Korea, with 49 new cases per 100,000 people and 629 multi-drug resistant (MDR) cases reported in 2020. TB is increasing among immigrants in S. Korea, and various TB case finding strategies are being performed for screening. We compared active case finding (ACF) with passive case finding (semi-PCF) across epidemiological characteristics and investigated a cost-effective strategy for screening immigrants for TB.

Methods: ACF driven by non-governmental organizations and semi-PCF as part of the government's visa renewal process using CXR with additional acid-fast bacilli (AFB) smear and cultures were performed. Epidemiological parameters were compared between the two TB screening projects, and costs were collected. Cost-effectiveness was evaluated using a decision analysis model from the health system perspective. The primary outcome was incremental cost-effectiveness ratio (ICER) per averted TB case. Additional probabilistic sensitivity analysis was conducted.

Results: ACF (2.02%) showed a higher TB prevalence rate than semi-PCF (0.67%) on CXR. For subjects older than 60 years, the suspected TB rate on CXR was significantly higher in ACF (36.6%) than in semi-PCF (12.2%) (P<0.01). TB incidence among the family visa type was significantly higher in ACF (1.96%) than in semi-PCF (0.88%) (P < 0.0012). Costs for ACF ($666.92) were $20.784 higher than for semi-PCF ($646.13), but TB progression decreased by 0.02, resulting in an ICER of $948.18 per averted TB case. In sensitivity analysis, the indirect costs of ACF and semi-PCF had the highest impact on ICER.

Conclusion: ACF found more TB cases than semi-PCF through CXR screening, and suspect cases with old age and family visa type were more common in ACF than in semi-PCF. ACF is cost-effective as a TB screening strategy for immigrants.

Copyright: © 2023 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Cost-Effectiveness Analysis*
Humans
Mass Screening / methods
Prevalence
Republic of Korea / epidemiology
Tuberculosis* / diagnosis
Tuberculosis* / epidemiology

Grants and funding

S. H. Lee received a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant number: HI20C1068). The roles of funders were monitoring the outcomes.