Cost-effectiveness analysis of preventive strategies for Tuberculosis among formerly-incarcerated individuals in Brazil

Abstract

Prisons serve as amplifiers of Tuberculosis (TB) transmission due to overpopulation, lack of hygiene, and bad ventilation [Mabud et al., 2019] [Baussano et al., 2010]. The risk of TB is elevated during and after incarceration, only returning to the general population’s risk seven years after liberation. This is an indication that formerly-incarcerated individuals are a highrisk group. By preventing TB among ex-prisoners, the burden and transmission to the general population can remain limited. This study aims to analyze the cost-effectiveness of various preventive measures among formerly-incarcerated individuals in Brazil. With the imprisonment rate growing in the country and the high TB incidence rates, Brazil can benefit greatly from proposed measures. The research mathematically models the effect of several interventions and quantifies associated health benefits and costs with the use of Disability Adjusted Life Years and Incremental Cost-Effectiveness Ratios. The parameters of the model are estimated with Bayesian statistics, using likelihood functions and prior distributions to calculate a posterior distribution. The results of the research indicate how the different interventions behave and which is most advisable for implementation in the Brazilian health system. Our conclusion is that shorter preventive therapies in combination with the skin test Tuberculin Skin Test perform better than longer therapies and/or the blood test Interferon Gamma Release Assays. This research was conducted in collaboration with the Harvard T.H. Chan School of Public Health and the TU Delft, with help from the Brazilian ministry of health.