Cost-effectiveness of screening for TB, hepatitis B and hepatitis C for asylum seekers to the UK

Abstract Background Asylum seekers experience large health inequalities and barriers across Europe. Screening for Hepatitis B (HBV), Hepatitis C (HCV) and Tuberculosis (TB) potentially prevents severe disease. We assessed cost-effectiveness of 3 screening strategies for asylum seekers arriving in the UK by small boats. Methods Three Markov decision-analytic models assessed the cost-effectiveness of ‘systematic screening’ at point of entry (within 3-5 days of arrival) compared to current practice (existing arrangement in primary care) and no screening over 40 years from a health service perspective. Model parameters were sourced from secondary literature, UK government, and NHS sources. We estimated incremental cost per quality-adjusted life year (QALY), incremental cost per case/death averted, and incremental cost-effectiveness ratios (ICERs) with 95% uncertainty intervals. Sensitivity analyses explored the impact of optimistic and pessimistic assumptions on key parameters (i.e., levels of screening uptake, treatment uptake, completion, and efficacy rates). Results In the base-case scenario, for TB, HBV, and HCV, systematic screening is a dominant strategy. compared to the alternatives. Systematic TB screening generated cost savings and QALY gains compared to current practice (cost savings: £222; QALY gains 0.10) and no screening (cost savings: £527; QALY gains 0.36). For HBV, systematic screening led to cost savings and QALY gains compared to current practice (cost savings £111; incremental QALY gains 0.02) and compared to no screening (cost savings £157; QALY gains 0.03). Similarly, for HCV, systematic screening resulted in cost savings (£23 and £33) and QALY gains (0.004 and 0.006) compared to the comparators. Sensitivity analyses led to similar findings. Conclusions Systematic screening of small boat migrants for TB, HBV, and HCV is cost-effective. Similar health economic analyses can be applied across Europe to inform policy to improve the health of asylum seekers. Key messages • Screening of asylum seekers for TB, HBV & HCV on arrival is likely to be cost-effective in the UK. • Health economic modelling could inform screening policy for asylum seekers entering Europe.