The effectiveness and cost-effectiveness of screening for active tuberculosis among migrants in the EU/EEA: A systematic review

Christina Greenaway*, Manish Pareek, Claire Nour Chakra Abou, Moneeza Walji, Iuliia Makarenko, Balqis Alabdulkarim, Catherine Hogan, Ted McConnell, Brittany Scarfo, Robin Christensen, Anh Tran, Nick Rowbotham, Teymur Noori, Marieke J. van der Werf, Kevin Pottie, Alberto Matteelli, Dominik Zenner, Rachael L. Morton

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

56 Citations (Scopus)


Background: The foreign-born population make up an increasing and large proportion of tuberculosis (TB) cases in European Union/European Economic Area (EU/EEA) low-incidence countries and challenge TB elimination efforts. Methods: We conducted a systematic review to determine effectiveness (yield and performance of chest radiography (CXR) to detect active TB, treatment outcomes and acceptance of screening) and a second systematic review on cost-effectiveness of screening for active TB among migrants living in the EU/EEA. Results: We identified six systematic reviews, one report and three individual studies that addressed our aims. CXR was highly sensitive (98%) but only moderately specific (75%). The yield of detecting active TB with CXR screening among migrants was 350 per 100,000 population overall but ranged widely by host country (110-2,340), migrant type (170-1,192), TB incidence in source country (19-336) and screening setting (220-1,720). The CXR yield was lower (19.6 vs 336/100,000) and the numbers needed to screen were higher (5,076 vs 298) among migrants from source countries with lower TB incidence (≤ 50 compared with ≥ 350/100,000). Cost-effectiveness was highest among migrants originating from high (≥ 120/100,000) TB incidence countries. The foreign-born had similar or better TB treatment outcomes than those born in the EU/EEA. Acceptance of CXR screening was high (85%) among migrants. Discussion: Screening programmes for active TB are most efficient when targeting migrants from higher TB incidence countries. The limited number of studies identified and the heterogeneous evidence highlight the need for further data to inform screening programmes for migrants in the EU/EEA.

Original languageEnglish
Article number17-00542
Issue number14
Publication statusPublished - 5 Apr 2018

Bibliographical note

Funding Information:
Funding: This work is supported by the European Centre for Disease Prevention and Control (ECDC); FWC No ECDC/2015/016; Specific Contract No 1 ECD.5748. Dr Manish Pareek is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, Dr Manish Pareek, PDF-2015-08-102). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Prof Rachael L Morton is supported by an NHMRC Public Health Fellowship #1054216.

Funding Information:
1. Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada 2. Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada 3. Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom 4. Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Québec, Canada 5. Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark 6. National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia 7. European Centre for Disease Prevention and Control, Stockholm, Sweden 8. C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada 9. Clinic of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, World Health Organization Collaborating Centre for TB/HIV and TB Elimination, Brescia, Italy 10. Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom 11. Department of Infection and Population Health, University College London, London, United Kingdom

Publisher Copyright:
© 2018, European Centre for Disease Prevention and Control (ECDC). All rights reserved.


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