New evidence suggests that focusing tuberculosis (TB) screenings on high-risk individuals in English prisons could be more cost-effective than universal screening, pointing the way toward more efficient healthcare strategies in correctional facilities.
Current Screening Practices
Despite the World Health Organization’s recommendations, newly admitted inmates in England’s prisons typically do not receive systematic TB infection screenings. This is a significant oversight given the elevated risk of TB in incarcerated populations compared to the general public.
Economic Analysis and Findings
A recent cost-effectiveness study evaluated the impact of introducing TB screenings upon entry into prisons. The analysis revealed that universal screening yields an incremental cost-effectiveness ratio (ICER) of £78,000 per quality-adjusted life-year (QALY) gained, which exceeds the usual threshold of £30,000. However, by targeting individuals from countries with high TB incidence rates and reducing costs associated with loss to follow-up and prison escort, the ICER was significantly lowered, with some strategies becoming cost-saving.
Key inferences include:
- Targeted screening can lead to financial savings by focusing resources on high-risk groups.
- Reducing loss to follow-up in TB care pathways enhances cost-effectiveness.
- Eliminating extramural escort costs contributes substantially to lowering overall expenses.
The study underscores that while universal TB screening in English prisons may not be economically justified, strategic targeting and cost-reduction measures offer a viable solution. Implementing these targeted approaches could improve public health outcomes within the prison system without imposing excessive costs on the healthcare system.
Effective TB control in prisons is crucial not only for the health of inmates but also for the broader community, as untreated TB can spread beyond prison walls. Policymakers should consider adopting targeted screening protocols, leveraging data on high-risk populations to optimize resource allocation. Additionally, addressing factors like loss to follow-up and reducing logistical costs can enhance the sustainability and effectiveness of TB interventions in correctional settings.
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