Cost of Tuberculosis (TB) screening and contact tracing an Eastern European immigrant population seasonally employed at an agricultural farm in the United Kingdom

<bold>BACKGROUND:</bold> Economic data inform public health measures; a co-ordinated approach to TB contact tracing, guided by Public Health England (PHE), was undertaken assessing a non-English speaking Eastern European immigrant population seasonally employed at an agricultural farm and we (1) report direct costs, (2) identify cultural issues and risks employing such a population <bold>Methods:</bold> After an initial pilot study of work-based contacts of an index case, contact lists incorporating workforce in every shift pattern back-dated two years to his UK entry were identified. Direct costs included T-spot testing (Oxford Immunotec) and translators (Romanian, Polish, Lithuanian, Italian) along with secondary care charges at tariff with uniform cross-charge among providers. TB drug costs (managing latent or disease) were from the British National Formulary. <bold>Results:</bold> 258/331 (78%) workers took up testing. 80 (31%) were then referred for contact screening; of these, 47 had latent and 3 active disease. 16 defaulted, 5 declined, 4 were pregnant, and 5 lost moved elsewhere. Most had no registered General Practitioner and no pre-employment health check, BCG or radiology. Anecdotally, several returned to their parent countries for healthcare advice despite measures to overcome language barriers. Main direct costs (£51,497-52) equated to £199-60/person screening and £1029-95/person treated for either latent or TB disease. <bold>Conclusions:</bold> Language and cultural barriers are challenges to TB screening/contact tracing. Direct costs are £200 (UK pound sterling = 1.17 Euro) per patient screened and five times this amount treating latent or active disease.