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Fig 1.

Model structure: Flow of new migrants through the simulation and the interventions investigated upon arrival in Canada.

LTBI: Latent tuberculosis infection.

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Fig 2.

Possible events that may result in movement between health states after arrival in Canada.

LTBI: Latent tuberculosis infection; TB: tuberculosis.

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Table 1.

Model parameters and analyses range.

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Table 2.

Discounted results of base case analysis of the population under medical surveillance.

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Table 3.

Results of LTBI cascade of care improvements in the population under medical surveillance.

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Table 4.

Results of expanding post-landing LTBI screening based on TB incidence in country of origin.

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Fig 3.

Efficiency frontier of population QALYs vs. population costs in the 2014 population of migrants under post-landing surveillance.

The frontier is read from left to right, with interventions connected if they fall on the frontier. Interventions subsequent to the initial intervention have an increased cost, but an increased benefit, and represent the next best value at increasing funding thresholds. The slope between two connected interventions represents cost-effectiveness: a steeper slope represents poorer cost-effectiveness between interventions, while a shallow slope represents better cost-effectiveness. QALY: quality adjusted life year; SEQ: sequential screening; TST: tuberculin skin test; IGRA: interferon-gamma release assay; INH: isoniazid; RIF: rifampin.

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Fig 4.

Cost-effectiveness acceptability curve for cost per QALY gained in the 2014 population of migrants under post-landing surveillance.

The graph demonstrates the probability an intervention is cost-effective at various willingness-to-pay thresholds in relation to the base case intervention. QALY: quality adjusted life year; SEQ: sequential screening; TST: tuberculin skin test; IGRA: interferon-gamma release assay; INH: isoniazid; RIF: rifampin.

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Fig 4 Expand

Fig 5.

Efficiency frontier of population QALYs vs. population costs in the complete 2014 cohort of migrants.

The frontier is read from left to right, with interventions connected if they fall on the frontier. Interventions subsequent to the initial intervention have an increased cost, but an increased benefit, and represent the next best value at increasing funding thresholds. The slope between two connected interventions represents cost-effectiveness: a steeper slope represents poorer cost-effectiveness between interventions, while a shallow slope represents better cost-effectiveness. QALY: quality adjusted life year; SEQ: sequential screening; TST: tuberculin skin test; IGRA: interferon-gamma release assay; INH: isoniazid; RIF: rifampin.

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Fig 5 Expand

Fig 6.

Cost-effectiveness acceptability curve for cost per QALY gained in the complete 2014 cohort of migrants.

The graph demonstrates the probability an intervention is cost-effective at various willingness-to-pay thresholds in relation to the base case intervention. QALY: quality adjusted life year; SEQ: sequential screening; TST: tuberculin skin test; IGRA: interferon-gamma release assay; INH: isoniazid; RIF: rifampin.

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Fig 6 Expand