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Abstract

Screening asylum seekers for infectious diseases is widely performed, but economic evaluations of such are scarce. We performed a policy analysis and economic evaluation of such screening in Germany, and analysed the effect of screening policies on cost differences between federal states. Of the 16 states, screening was compulsory for tuberculosis (TB) in asylum seekers ≥ 16 years of age in all states as well as in children < 16 years of age and pregnant women in six states, hepatitis B and enteropathogens in three, syphilis in two and human immunodeficiency virus (HIV) in one state. Of 441,899 asylum seekers, 88.0% were screened for TB, 22.9% for enteropathogens, 16.9% for hepatitis B, 13.1% for syphilis and 11.3% for HIV. The total costs for compulsory screening in 2015 were 10.3 million euros (EUR). Costs per case were highest for infections with spp. (80,200 EUR), spp. (8,000 EUR), TB in those ≥ 16 years of age (5,300 EUR) and syphilis (1,150 EUR). States with extended screening had per capita costs 2.84 times those of states that exclusively screened for TB in asylum seekers ≥ 16 years of age (p < 0.0001, 95% confidence interval (CI): 1.96–4.10). Screening practices in Germany entailed high costs; evidence-based approaches to infectious disease screening are needed.

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2017-10-05
2024-04-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.40.16-00677
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References

  1. Norredam M, Mygind A, Krasnik A. Access to health care for asylum seekers in the European Union--a comparative study of country policies. Eur J Public Health. 2006;16(3):285-90.  https://doi.org/10.1093/eurpub/cki191  PMID: 16230318 
  2. Kärki T, Napoli C, Riccardo F, Fabiani M, Dente MG, Carballo M, et al. Screening for infectious diseases among newly arrived migrants in EU/EEA countries--varying practices but consensus on the utility of screening. Int J Environ Res Public Health. 2014;11(10):11004-14.  https://doi.org/10.3390/ijerph111011004  PMID: 25337945 
  3. U.S. Department of State. U.S. Refugee Admissions Program. Washington DC: U.S. Department of State; 2017. [Accessed 22 Sep 2017]. Available from: https://www.state.gov/j/prm/ra/admissions/
  4. Australia Government Department of Health. Medicare Benefits Schedule (MBS) Health assessment for refugees and other humanitarian entrants. Canberra: Department of Health; 24 Sep 2014. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare_mbsitem_refugees
  5. Robert Koch Institut. (RKI). Vorscreening und Erstaufnahmeuntersuchung für Asylsuchende. [Pre-screening and upon-entry health examination for asylum seekers]. Berlin: RKI; 20 Nov 2015. German. Available from: https://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GesundAZ/Content/A/Asylsuchende/Inhalt/Erstaufnahmeuntersuchung_Tab.html
  6. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al. Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2011;183(12):E824-925.  https://doi.org/10.1503/cmaj.090313  PMID: 20530168 
  7. Wilson JMG, Jungner G. Public Health Papers 34: Principles and practice of screening for disease. Geneva: World Health Organization; 1968. Available from: http://apps.who.int/iris/bitstream/10665/37650/17/WHO_PHP_34.pdf
  8. Andermann A, Blancquaert I, Beauchamp S, Déry V. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bull World Health Organ. 2008;86(4):317-9.  https://doi.org/10.2471/BLT.07.050112  PMID: 18438522 
  9. European Centre for Disease Prevention and Control (ECDC). Evidence-based guidance for the prevention of infectious diseases among newly arrived migrants in the EU/EEA. Stockholm: ECDC; 5 Oct 2016. Available from: https://ecdc.europa.eu/en/news-events/evidence-based-guidance-prevention-infectious-diseases-among-newly-arrived-migrants-0
  10. United Nations High Commissioner for Refugees (UNHCR). Global Trends: Forced Displacement in 2015. Geneva: UNHCR; 20 Jun 2016. Available from: http://www.unhcr.org/statistics/unhcrstats/576408cd7/unhcr-global-trends-2015.html
  11. Gemeinsame Wissenschaftskonferenz (GWK). Königsteiner Schlüssel. [Königstein Quota]. Bonn: GWK; 2017. [Accessed 20 Sep 2017]. German. Available from: www.gwk-bonn.de/Themen/koenigsteiner-schluessel/
  12. Bozorgmehr K, Szecsenyi J, Stock C, Razum O. Europe’s response to the refugee crisis: why relocation quotas will fail to achieve ‘fairness’ from a health perspective. Eur J Public Health. 2016;26(1):5-6.  https://doi.org/10.1093/eurpub/ckv246  PMID: 26839338 
  13. Bozorgmehr K, Nöst S, Thaiss MH, Razum O. Die gesundheitliche Versorgungssituation von Asylsuchenden: Bundesweite Bestandsaufnahme über die Gesundheitsämter. [Health care provisions for asylum-seekers: a nationwide survey of public health authorities in Germany]. Bundesgesundheitsblatt. 2016;59(5):545-55. German.  https://doi.org/10.1007/s00103-016-2329-4 
  14. Razum O, Bunte A, Gilsdorf A, Ziese T, Bozorgmehr K. Gesundheitsversorgung von Geflüchteten: Zu gesicherten Daten kommen. [Health care for refugees: obtaining reliable data]. Dtsch Arztebl. 2016;113:A130-3. German. Available from: https://www.aerzteblatt.de/pdf/113/4/a130.pdf
  15. Hvass AMF, Wejse C. Systematic health screening of refugees after resettlement in recipient countries: a scoping review. Ann Hum Biol. 2017;44(5):475-83.  https://doi.org/10.1080/03014460.2017.1330897  PMID: 28562071 
  16. Federal Office for Migration and Refugees (BAMF). Das Bundesamt in Zahlen 2015. Asyl, Migration und Integration. [The Federal Office in numbers 2015. Asylum, Migration and Integration]. Nürnberg: BAMF; 10 Oct 2016. German. Available from: https://www.bamf.de/SharedDocs/Anlagen/DE/Publikationen/Broschueren/bundesamt-in-zahlen-2015.pdf?__blob=publicationFile
  17. Kassenärztliche Bundesvereinigung (KBV). Online Version des EBM. [Online version of the unified reimbursement scheme EBM]. Berlin: KBV. [Accessed 1 Apr 2016]. German. Available from: http://www.kbv.de/html/online-ebm.php http://www.kbv.de/html/online-ebm.php
  18. Verband der Privaten Krankenversicherungen (PKV). Gebührenordnung für Ärzte (GOÄ) mit verkürzten Leistungsbezeichnungen - Kurz-GOÄ-. [Reimbursement scheme of private physicians (GOÄ) with short codes (Kurz-GOÄ)]. Köln, Berlin: PKV; Aug 2013. German. Available from: https://www.pkv.de/service/broschueren/rechtsquellen/gebuehrenordnung-fuer-aerzte.pdb.pdf?dl=1
  19. Hörmansdörfer S, Bengs K, Berger A, Bischoff H, Sing A. Bakteriologische Stuhluntersuchungen bei Asylbewerbern in Bayern – Entwicklungen und Ergebnisse. [Bacteriological stool examinations in asylum seekers in Bavaria – Developments and Results]. Gesundheitswesen. 2016;78(04):40.  https://doi.org/10.1055/s-0036-1578938 
  20. Sing A, Hierl W. Gesundheitsuntersuchung nach dem Asylverfahrensgesetz. [Health examination according to the Asylum Procedure Act]. Bayerisches Ärzteblatt. 2015;9:422-423. German. Available from: http://www.bayerisches-aerzteblatt.de/fileadmin/aerzteblatt/ausgaben/2015/09/einzelpdf/BAB_9_422_423.pdf
  21. Bozorgmehr K, Razum O, Saure D, Joggerst B, Szecsenyi J, Stock C. Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis. Euro Surveill. 2017;22(12):30491.  https://doi.org/10.2807/1560-7917.ES.2017.22.12.30491  PMID: 28367795 
  22. Arshad S, Bavan L, Gajari K, Paget SNJ, Baussano I. Active screening at entry for tuberculosis among new immigrants: a systematic review and meta-analysis. Eur Respir J. 2010;35(6):1336-45.  https://doi.org/10.1183/09031936.00054709  PMID: 19840970 
  23. Hyde R. Refugees need health cards, say German doctors. Lancet. 2016;388(10045):646-8.  https://doi.org/10.1016/S0140-6736(16)31346-0  PMID: 27533428 
  24. Bozorgmehr K, Razum O. Refugees in Germany-untenable restrictions to health care. Lancet. 2016;388(10058):2351-2.  https://doi.org/10.1016/S0140-6736(16)32131-6  PMID: 27845093 
  25. Lönnroth K, Migliori GB, Abubakar I, D’Ambrosio L, de Vries G, Diel R, et al. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J. 2015;45(4):928-52. PMID: 25792630 
  26. van der Werf MJ, Lönnroth K. Pre-entry, post-entry, or no tuberculosis screening? Lancet Infect Dis. 2014;14(12):1171-2.  https://doi.org/10.1016/S1473-3099(14)70998-3  PMID: 25455973 
  27. Junk L, Nießen J, Pruskil S, Tadzic R. Erfahrungen aus dem Syphillisscreening bei Flüchtlingen in Hamburg. [Experiences with syphillis screening in refugees in Hamburg]. Abstract-Band STI-Kongress 2016 mit Leopoldina-Symposium; 2016 Jul 7-9. Berlin. Bochum: Deutsche STI-Gesellschaft. p. 13-14. German. Available from: http://dstig.de/images/Kongress_2016/abstracts_sti%20kongress2016.pdf
  28. Gushulak B, Weekers J, Macpherson D. Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework. Emerg Health Threats J. 2009;2(0):e10.  https://doi.org/10.3402/ehtj.v2i0.7091  PMID: 22460280 
  29. Bozorgmehr K, Joggerst B, Wagner U, Stock C. Yield of tuberculosis screening in asylum-seekers by country of origin: analysis of screening data in a German federal state (2002-2015). Eur Respir J. 2017;49(4):1602327.  https://doi.org/10.1183/13993003.02327-2016  PMID: 28424363 
  30. Razum O, Bozorgmehr K. Restricted entitlements and access to health care for refugees and immigrants: The example of Germany. Glob Soc Policy. 2016;16(3):321-4.  https://doi.org/10.1177/1468018116655267 
  31. Bozorgmehr K, Razum O. Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994-2013. PLoS One. 2015;10(7):e0131483.  https://doi.org/10.1371/journal.pone.0131483  PMID: 26201017 
  32. Fazel M, Reed RV, Panter-Brick C, Stein A. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet. 2012;379(9812):266-82.  https://doi.org/10.1016/S0140-6736(11)60051-2  PMID: 21835459 
  33. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309-14.  https://doi.org/10.1016/S0140-6736(05)61027-6  PMID: 15823380 
  34. Bozorgmehr K, Mohsenpour A, Saure D, Stock C, Loerbroeks A, Joos S, et al. Systematische Übersicht und „Mapping“ empirischer Studien des Gesundheitszustands und der medizinischen Versorgung von Flüchtlingen und Asylsuchenden in Deutschland (1990–2014). [Systematic review and evidence mapping of empirical studies on health status and medical care among refugees and asylum seekers in Germany (1990–2014)]. Bundesgesundheitsblatt. 2016;59(5):599-620.  https://doi.org/10.1007/s00103-016-2336-5 
  35. Baron J, Flory L. Versorgungsbericht: Zur psychosozialen Versorgung von Flüchtlingen und Folteropfern in Deutschland. [Report on psychosocial care of refugees and victims of torture in Germany]. Berlin: Bundesweite Arbeitsgemeinschaft der psychosozialen Zentren für Flüchtlinge und Folteropfer; 2016. German. Available from: http://www.baff-zentren.org/wp-content/uploads/2017/02/Versorgungsbericht_3-Auflage_BAfF.pdf
  36. Bundesverband Deutscher Psychologinnen und Psychologen (BDP). Durchschnittliche Jahresgehälter von Psychologen. Eingruppierung nach TVÖD Kommunale Arbeitgeber 2015. [Average annual income of psychologists. Payment scale of public service TVÖD community employers]. Berlin: BDP; 2017. [Accessed 28 Sep 2017]. German. Available from: https://www.bdp-verband.de/beruf/gehalt.shtml
  37. Bundesministerium des Inneren (BMI). 890.000 Asylsuchende im Jahr 2015. [890.000 asylum seekers in the year 2015]. Berlin: BMI; 30 Sep 2016. German. Available from: http://www.bmi.bund.de/SharedDocs/Pressemitteilungen/DE/2016/09/asylsuchende-2015.html
Infectious disease screening in asylum seekers: range, coverage and economic evaluation in Germany, 2015
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Kayvan+Bozorgmehr&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bozorgmehr Kayvan</a>, <a href="/search?value1=Katharina+Wahedi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wahedi Katharina</a>, <a href="/search?value1=Stefan+Noest&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Noest Stefan</a>, <a href="/search?value1=Joachim+Szecsenyi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Szecsenyi Joachim</a>, <a href="/search?value1=Oliver+Razum&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Razum Oliver</a></span>. Infectious disease screening in asylum seekers: range, coverage and economic evaluation in Germany, 2015. <a href="/content/ecdc">Euro Surveill.</a> 2017;22(40):pii=16-00677. <a href="https://doi.org/10.2807/1560-7917.ES.2017.22.40.16-00677" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2017.22.40.16-00677</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 10 Oct 2016;&nbsp;&nbsp; <span class="generated">Accepted</span>: 11 May 2017 </span> </p>
/content/10.2807/1560-7917.ES.2017.22.40.16-00677
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