Table 4

Projected cases of active tuberculosis (TB) and associated costs arising from undertaking immigrant screening using different screening tools at different screening thresholds (arranged in order of increasing effectiveness—ie, fewer cases of active TB) for a hypothetical cohort of 10 000 immigrants over a 20-year time horizon

CXR at port of arrivalScreening for LTBICases of active TB (over 20 years)Costs (£, 2010)Incremental cases of active TBIncremental costs (£, 2010)ICER
Screening toolScreening threshold for immigrants (cases of TB/100 000 per year)
NoNoneNone100.5659 609.4BaselineBaselineBaseline
NoTST plus QFN350100.4690 521.6Extended dominanceExtended dominanceExtended dominance
NoTST plus T-SPOT.TB350100.3696 433.4Extended dominanceExtended dominanceExtended dominance
NoTST350100.1706 478.7Strict dominanceStrict dominanceStrict dominance
NoTST plus QFN300100.0707 756.2Strict dominanceStrict dominanceStrict dominance
NoTST plus T-SPOT.TB30099.8715 317.0Strict dominanceStrict dominanceStrict dominance
NoQFN35099.4701 675.9Extended dominanceExtended dominanceExtended dominance
NoTST30099.4721 759.0Extended dominanceExtended dominanceExtended dominance
NoT-SPOT.TB35099.3728 560.7Strict dominanceStrict dominanceStrict dominance
YesNoneNone98.9754 339.9Strict dominanceStrict dominanceStrict dominance
YesTST plus QFN35098.8785 252.0Strict dominanceStrict dominanceStrict dominance
YesTST plus T-SPOT.TB35098.7791 163.9Strict dominanceStrict dominanceStrict dominance
YesTST35098.5801 209.1Strict dominanceStrict dominanceStrict dominance
YesTST plus QFN30098.4802 486.6Strict dominanceStrict dominanceStrict dominance
YesTST plus T-SPOT.TB30098.2810 047.5Strict dominanceStrict dominanceStrict dominance
NoQFN30098.0723 513.2Extended dominanceExtended dominanceExtended dominance
YesQFN35097.8796 406.3Strict dominanceStrict dominanceStrict dominance
YesTST30097.8816 489.4Strict dominanceStrict dominanceStrict dominance
NoTST plus QFN25097.8793 192.7Strict dominanceStrict dominanceStrict dominance
NoT-SPOT.TB30097.7751 926.8Extended dominanceExtended dominanceExtended dominance
YesT-SPOT.TB35097.7823 291.1Strict dominanceStrict dominanceStrict dominance
NoTST plus T-SPOT.TB25097.3813 690.1Extended dominanceExtended dominanceExtended dominance
YesQFN30096.4818 243.7Extended dominanceExtended dominanceExtended dominance
YesTST plus QFN25096.2887 923.2Strict dominanceStrict dominanceStrict dominance
NoTST25096.2823 749.7Extended dominanceExtended dominanceExtended dominance
YesT-SPOT.TB30096.1846 657.3Strict dominanceStrict dominanceStrict dominance
YesTST plus T-SPOT.TB25095.7908 420.5Strict dominanceStrict dominanceStrict dominance
NoTST plus QFN20095.6867 394.4Strict dominanceStrict dominanceStrict dominance
NoTST plus T-SPOT.TB20095.0913 943.4Strict dominanceStrict dominanceStrict dominance
YesTST25094.6918 480.1Strict dominanceStrict dominanceStrict dominance
YesTST plus QFN20094.0962 124.9Strict dominanceStrict dominanceStrict dominance
NoTST20093.8995 462.9Strict dominanceStrict dominanceStrict dominance
YesTST plus T-SPOT.TB20093.41 008 673.9Strict dominanceStrict dominanceStrict dominance
NoTST plus QFN15093.0954 636.7Strict dominanceStrict dominanceStrict dominance
NoTST plus T-SPOT.TB15092.31 023 409.3Strict dominanceStrict dominanceStrict dominance
YesTST20092.21 090 193.4Strict dominanceStrict dominanceStrict dominance
NoQFN25092.1839 713.78.4180 104.321 565.3
NoTST plus QFN10091.51 018 843.7Strict dominanceStrict dominanceStrict dominance
YesTST plus QFN15091.41 049 367.2Strict dominanceStrict dominanceStrict dominance
NoT-SPOT.TB25091.3909 426.7Extended dominanceExtended dominanceExtended dominance
NoTST plus T-SPOT.TB10090.71 113 644.2Strict dominanceStrict dominanceStrict dominance
YesTST plus T-SPOT.TB15090.71 118 139.7Strict dominanceStrict dominanceStrict dominance
NoTST15090.61 149 671.8Strict dominanceStrict dominanceStrict dominance
YesQFN25090.6934 444.2Extended dominanceExtended dominanceExtended dominance
YesTST plus QFN10089.91 113 574.1Strict dominanceStrict dominanceStrict dominance
YesT-SPOT.TB25089.71 004 157.2Strict dominanceStrict dominanceStrict dominance
NoQFN20089.1959 014.5Extended dominanceExtended dominanceExtended dominance
YesTST plus T-SPOT.TB10089.11 208 374.6Strict dominanceStrict dominanceStrict dominance
NoTST10089.01 319 841.4Strict dominanceStrict dominanceStrict dominance
YesTST15089.01 244 402.3Strict dominanceStrict dominanceStrict dominance
NoT-SPOT.TB20088.21 171 831.5Strict dominanceStrict dominanceStrict dominance
YesQFN20087.61 053 744.9Extended dominanceExtended dominanceExtended dominance
YesTST10087.41 414 571.9Strict dominanceStrict dominanceStrict dominance
YesT-SPOT.TB20086.61 266 562.0Strict dominanceStrict dominanceStrict dominance
NoTST plus QFN4086.51 159 835.9Strict dominanceStrict dominanceStrict dominance
NoTST plus T-SPOT.TB4085.51 296 089.2Strict dominanceStrict dominanceStrict dominance
Yes TST plus QFN 40 84.9 1254566.3 Strict dominance Strict dominance Strict dominance
NoQFN15084.31 089 176.57.8249 462.831 867.1
Yes TST plus T-SPOT.TB 40 83.9 1390819.6 Strict dominance Strict dominance Strict dominance
NoTST4083.31 597 273.1Strict dominanceStrict dominanceStrict dominance
NoT-SPOT.TB15083.01 408 873.0Strict dominanceStrict dominanceStrict dominance
NoQFN10082.81 195 634.0Strict dominanceStrict dominanceStrict dominance
YesQFN15082.71 183 906.9Extended dominanceExtended dominanceExtended dominance
YesTST4081.71 692 003.5Strict dominanceStrict dominanceStrict dominance
NoT-SPOT.TB10081.51 666 546.8Strict dominanceStrict dominanceStrict dominance
YesT-SPOT.TB15081.41 503 603.4Strict dominanceStrict dominanceStrict dominance
YesQFN10081.21 290 364.5Extended dominanceExtended dominanceExtended dominance
YesT-SPOT.TB10079.91 761 277.3Strict dominanceStrict dominanceStrict dominance
NoQFN4074.91 414 623.39.4325 446.834 753.5
Yes QFN 40 73.4 1509353.7 1.6 94730.4 59489.1
NoT-SPOT.TB4073.32 095 182.0Extended dominanceExtended dominanceExtended dominance
Yes T-SPOT.TB 40 71.7 2189912.4 1.7 680558.7 402421.8
  • *Ranking different strategies from least effective to most effective (ie, number of cases of active TB predicted to occur) results in the ICERs of most screening options being excluded through extended dominance, which is when the ICER for a particular screening threshold is higher than for the next most effective strategy (screening threshold) and so the higher ICER is removed from the cost-effectiveness analysis.

  • †Current National Institute for Clinical Excellence guidance recommends screening with CXR on arrival, using single-step IGRA or dual TST plus confirmatory IGRA at an incidence threshold of 40/100 000 (bold rows).

  • CXR, chest x-ray; ICER, incremental cost-effectiveness ratio; IGRA, interferon γ release assay; LTBI, latent tuberculosis infection; QFN, QuantiFERON Gold in-tube; TST, tuberculin skin test.