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Cost-effectiveness of interferon-gamma release assay screening for latent tuberculosis infection treatment in Germany |
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| Authors: | Diel Roland Nienhaus Albert Loddenkemper Robert |
| Institution: | School of Public Health, c/o Institute for Medical Sociology, Heinrich Heine University, Post Box 101007, D-40001 Düsseldorf, Germany. Roland.Diel@uni-duesseldorf.de |
| Abstract: | OBJECTIVES: To assess the cost-effectiveness of the new QuantiFERON-TB Gold In-Tube (QFT-G) Cellestis; Carnegie, VIC, Australia] assay for screening and treating of persons who have had close contact with tuberculosis (TB) patients and are suspected of having latent tuberculosis infection (LTBI) hereafter called close-contacts] in Germany. METHODS: The health and economic outcomes of isoniazid treatment of 20-year-old close-contacts were compared in a Markov model over a period of 20 years, using two different cutoff values for the tuberculin skin test (TST), the QFT-G assay alone, or the QFT-G assay as a confirmatory test for the TST results. RESULTS: QFT-G assay-based treatment led to cost savings of $542.9 and 3.8 life-days gained per LTBI case. TST-based treatment at a 10-mm induration size cutoff gained $177.4 and 2.0 life-days gained per test-positive contact. When the cutoff induration size for the TST was reduced to 5 mm, the incremental cost-effectiveness ratio fell below the willingness-to-pay threshold ($30,170 per life-years gained) but resulted in unnecessary treatment of 77% of contacts owing to false-positive TST results. Combination with the 5-mm induration size TST cutoff value compared to the results of the QFT-G assay alone reduced the total costs per 1,000 contacts by 1.8% to $222,869. The number treated to prevent 1 TB case was 22 for the two QFT-G assay-based procedures, 40 for the TST at a cutoff induration size of 10 mm, and 96 for the TST at a cutoff induration size of 5 mm. When the sensitivity rates of the TST and the QFT-G assay were compounded, the QFT-G assay strategy alone was slightly less costly (0.6%) than the two-step approach. CONCLUSIONS: Using the QFT-G assay, but especially combining the QFT-G assay following the TST screening of close-contacts at a cutoff induration size of 5 mm before LTBI treatment is highly cost-effective in reducing the disease burden of TB. |
| Keywords: | contact investigation cost-effectiveness interferon-γ release assay latent tuberculosis infection latent tuberculosis infection treatment number needed to treat tuberculosis BCG"} {"#name":"keyword" "$":{"id":"cekeyw90"} "$$":[{"#name":"text" "_":"bacillus Calmette-Guerin CI"} {"#name":"keyword" "$":{"id":"cekeyw110"} "$$":[{"#name":"text" "_":"confidence interval FN"} {"#name":"keyword" "$":{"id":"cekeyw130"} "$$":[{"#name":"text" "_":"false-negative FP"} {"#name":"keyword" "$":{"id":"cekeyw150"} "$$":[{"#name":"text" "_":"false-positive ICER"} {"#name":"keyword" "$":{"id":"cekeyw170"} "$$":[{"#name":"text" "_":"incremental cost-effectiveness ratio IGRA"} {"#name":"keyword" "$":{"id":"cekeyw190"} "$$":[{"#name":"text" "_":"interferon-γ release assay INH"} {"#name":"keyword" "$":{"id":"cekeyw210"} "$$":[{"#name":"text" "_":"isoniazid LTBI"} {"#name":"keyword" "$":{"id":"cekeyw230"} "$$":[{"#name":"text" "_":"latent tuberculosis infection LY"} {"#name":"keyword" "$":{"id":"cekeyw250"} "$$":[{"#name":"text" "_":"life-year LYG"} {"#name":"keyword" "$":{"id":"cekeyw270"} "$$":[{"#name":"text" "_":"life-year gained MTB"} {"#name":"keyword" "$":{"id":"cekeyw290"} "$$":[{"#name":"text" "$$":[{"#name":"italic" "_":"Mycobacterium tuberculosis NNT"} {"#name":"keyword" "$":{"id":"cekeyw310"} "$$":[{"#name":"text" "_":"number needed to treat NPV"} {"#name":"keyword" "$":{"id":"cekeyw330"} "$$":[{"#name":"text" "_":"negative predictive value PPV"} {"#name":"keyword" "$":{"id":"cekeyw350"} "$$":[{"#name":"text" "_":"positive predictive value QFT-G"} {"#name":"keyword" "$":{"id":"cekeyw370"} "$$":[{"#name":"text" "_":"QuantiFERON-TB Gold In-Tube TB"} {"#name":"keyword" "$":{"id":"cekeyw390"} "$$":[{"#name":"text" "_":"tuberculosis TN"} {"#name":"keyword" "$":{"id":"cekeyw410"} "$$":[{"#name":"text" "_":"true-negative TP"} {"#name":"keyword" "$":{"id":"cekeyw430"} "$$":[{"#name":"text" "_":"true-positive tpDcm"} {"#name":"keyword" "$":{"id":"cekeyw450"} "$$":[{"#name":"text" "_":"probability of death due to TB tpReact"} {"#name":"keyword" "$":{"id":"cekeyw470"} "$$":[{"#name":"text" "_":"transition probability for a progression to manifest TB TST"} {"#name":"keyword" "$":{"id":"cekeyw490"} "$$":[{"#name":"text" "_":"tuberculin skin test |
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