Infectious disease screening in asylum-seekers: range, coverage and economic evaluation in Germany (2015)

Objective:

To assess (i) the range, coverage, and costs of compulsory screening in asylum-seekers in Germany; and (ii) the effect of screening policies on between-state differences in screening costs.

Methods:

Content analysis of screening policies for infectious diseases in Germany“s 16 federal states followed by an economic evaluation using secondary and publicly available data. Outcome measures: estimates of yield, total direct costs of compulsory screening and costs per identified case of disease in 441,899 first-applicant asylum-seekers in 2015.

Results:

Screening was compulsory for tuberculosis (TB) in asylum-seekers ≥16 years in all federal states, TB in children (< 16 years) and pregnant women (6 of 16 states), hepatitis B (3/16), human immunodeficiency virus (HIV) (1/16), syphilis (2/16) and enteropathogens (3/16). Of all asylum-seekers (N = 441,899), 88.0% (n = 389,052) were screened for TB, 22.9% (n = 101,255) for enteropathogens, 16.9% for hepatitis B (n = 74,568), 13.1% for syphilis (n = 58,002) and 11.3% for HIV (n = 49,793). Total costs were 10.3 million Euros (€) and costs per identified case were highest for Shigella (about 80,200 €), Salmonella (8,000 €), TB in asylum-seekers ≥16 years (5,300 €) and syphilis (1,150 €). The per capita costs of screening in states with extensive screening were 2.84 (p < 0.0001; 95%CI: 1.96 – 4.10) times the costs of states which exclusively performed screening for TB.

Conclusion:

The range of compulsory screening for infectious diseases varied between states and a substantial proportion of asylum-seekers were affected by mandatory screening for STIs and enteropathogens. The screening practices entailed high total costs, and very high costs per identified case for specific diseases with low yields, such as Shigella, Salmonella, and syphilis. More rational and evidence-based approaches to infectious disease screening in asylum-seekers are urgently needed.