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Table 1 Inputs to a model estimating costs of tuberculosis screening among Indian and Mexican nonimmigrant visa applicants, base case

From: Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas

 

India

Mexico

Source

H-1B (High skilled work visas)

H-4 (Family members of H-1B)

H-2A (Agricultural work visa)

H-2B (Seasonal work visa)

Average annual visa issuances

70,577

43,766

55,189

35,298

[6, 21]

Hypothetical cohorta

63,520

39,389

49,670

31,769

Assumption

Total active TB cases in cohort

138

86

32

20

Calculation

India and mexico inputs

 % with clinical findings suggestive of TBb

3.35

3.35

2.2

2.2

TB Indicator data

 Persons identified as Class B1c

2128

1320

1068

683

TB Indicator data

 % with active TB among those with clinical findings suggestive of TB

4.0

4.0

2.3

2.3

TB Indicator data

 Total number of active TB cases in home countries (prevalent cases)d

85

53

25

16

Calculation

 % of patients with active TB who enroll at panel physician sites

61

61

77

77

TB Indicator data

 Time for screeninge

1 day

1 day

1 day

1 day

 

 Time for diagnosise

3 days

3 days

3 days

3 days

 

 Time spent on treatment at panel physician sitee

30% of 6 months treatment

30% of 6 months treatment

30% of 6 months treatment

30% of 6 months treatment

 

 Time spent at a local treatment sitee

237.5 h

237.5

237.5

237.5

Calculation

Domestic Inputs

 % of Class B1s who will develop active TB in the U.S.

2.6

2.6

0.6

0.6

EDN 2011–2014

 Number of Class B1s who will develop active TB in the U.S. (incident cases)

53

33

6

4

EDN 2011–2014

 % receiving DOT only

62

62

62

62

[22]

 % receiving DOT and SAT

29.3

29.3

35

29.3

[22]

 % receiving SAT only

8.7

8.7

3.2

8.7

[22]

 % receiving DOT, healthcare worker visits patient

60

60

1

60

Assumption

 % receiving DOT, patient visits health department

40

40

0

40

Assumption

 % hospitalized (active detection)f

8

8

8

8

[23]

 % hospitalized (passive detection)g

49

49

49

49

[23]

 % presenting for follow-up at PHDs

78.6

78.6

78.6

78.6

[24]

 % receiving a simple follow-up

10.76

10.76

8.46

8.46

EDN 2011–2014

 % receiving only chest radiograph

28.44

28.44

39.04

39.04

EDN 2011–2014

 % Receiving chest radiograph, smears, and cultures

39.4

39.4

31.1

31.1

EDN 2011–2014

 Time for diagnostic visitse

2 h

2 h

2.5 h

2 h

 

 Time for treatment administratione

  Healthcare worker visits patient

8 min/visit

8 min/ visit

8 min/visit

8 min/visit

Assumption based on previous study [13]

  Patient visits PHD

1 h/visit

1 h/visit

Does not travel

1 h/visit

Assumption based on previous study [13]

 Time for follow-up visitse

1.5 h/visit

1.5 h/visit

2 h/visit

1.5 h/visit

Assumption based on previous study [13]

 Disease impairment

12.5 days

12.5 days

12.5 days

12.5 days

[25]

 Hospitalization

14 days

14 days

14 days

14 days

[26]

  1. Notes: Numbers may not add up due to rounding
  2. TB Tuberculosis, DOT Directly observed therapy, SAT Self-administered therapy, EDN Electronic Disease Notification System, NIV Non-immigrant visa applicant
  3. aCohort size was calculated by averaging the number of country-specific visa issuances over a 3-year period (2012–2013), and reducing by 10% [6]
  4. bFor India, this parameter is varied in a sensitivity analysis to account potential differences in the Indian immigrant versus NIV rates for signs and symptoms of TB
  5. cNumber of Class B1 NIVs was computed by subtracting the total number of active TB cases from the total number of with clinical findings suggestive of TB cases
  6. dTB cases among persons with Class B1 designations = Total persons with Class B1 designation x proportion of those with B1 designation that are diagnosed at U.S. follow-up
  7. eOpportunity costs were estimated for applicants for screening, diagnosis, and treatment using average annual wages for each visa category. Wages were obtained from the Bureau of Labor Statistics (BLS) or international sources. International wages were converted to dollars using PPP. For Indian H-1B workers, 1 h = $37.43 [27]. H-2A and H-2B workers’ wages in Mexico were obtained from International Labour Office (H-2A: 1 h = $2.46. H-2B: 1 h = $3.27) [28]. These wages were not adjusted for benefits. Time costs for Indian family members were based on GDP adjusted for PPP [29]
  8. Total compensation was estimated to be $56.25 per hour [30]. Agricultural workers (H-2A) wages were obtained from the BLS. Total compensation was estimated to be $13.34 per hour [30]. Seasonal workers’ (H-2B) time was valued using average wages for the top five occupations for H-2B foreign certifications [19, 30]. H-2B visa applicants’ wages were reduced by 20% because these workers are paid less than their U.S. counterparts. Total compensation for H-2B visa holders was estimated to be $13.52/h. Total compensation includes benefits
  9. fCases diagnosed actively via public health department follow-up is calculated by multiplying the total number of active cases expected in the population x the percentage that follow up at public health departments
  10. gCases diagnosed passively are for individuals who do not report to public health departments for follow-up and develop active TB