CHDS affiliate Yuli (Lily) Hsieh recently published a cost-effectiveness analysis of tuberculosis (TB) screening among US migrants. Between 2017 and 2021, 71% of TB cases were in non-U.S.-born individuals and the majority of those infections were attributed to infection acquired before entry into the U.S. Therefore, testing and offering preventive therapy to individuals at higher risk of developing TB disease from TB infection has been a core prevention strategy in the United States. Currently recommended screening using interferon-gamma release assays (IGRA) have low positive predictive value for disease progression, however, and many individuals who test positive with IGRA would not go on to develop TB disease even in the absence of preventive therapy.
Hsieh and colleagues developed a discrete-event simulation model to compare the lifetime TB related health and cost impact of four post-arrival TB screening strategies using host-response-based transcriptional signatures (HrTS), alone or in combination with IGRA, on U.S. migrants. Their model was individual-based with granular, time-dependent TB risk estimates based on each migrant’s age, entry year, country of origin and number of years in the U.S. Their findings suggest that HrTS could potentially be cost-effective, but the results were sensitive to several modelling assumptions that warrant further investigation, including the underlying TB risk migrants experience over time after entering the United States.
The article was one of Hseih’s doctoral dissertation papers. Hseih graduated from the Harvard PhD Program in Health Policy in May, 2025, and is currently a Senior Scientist for Real World Evidence Generation at Tempus AI.
Learn more: Read the full article, Cost-Effectiveness of Screening with Transcriptional Signatures for Incipient TB among U.S. Migrants
Learn more: Explore the CHDS Approach to Cost-Effectiveness Analysis
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