TY - JOUR
T1 - QuantiFERON-TB gold in-tube implementation for latent tuberculosis diagnosis in a public health clinic
T2 - A cost-effectiveness analysis
AU - Shah, Maunank
AU - Miele, Kathryn
AU - Choi, Howard
AU - DiPietro, Danielle
AU - Martins-Evora, Maria
AU - Marsiglia, Vincent
AU - Dorman, Susan
N1 - Funding Information:
The authors gratefully acknowledge the BCHD TB staff including Nicketta Paige, Barbara Johnson, Leona Mason, and Karla Alwood for their insights regarding the BCHD TB Program. MS is supported through a National Institutes Health K23 grant (AI089259) to study novel TB diagnostics. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
PY - 2012/12/19
Y1 - 2012/12/19
N2 - Background: The tuberculin skin test (TST) has limitations for latent tuberculosis infection (LTBI) diagnosis in low-prevalence settings. Previously, all TST-positive individuals referred from the community to Baltimore City Health Department (BCHD) were offered LTBI treatment, after active TB was excluded. In 2010, BCHD introduced adjunctive QuantiFERON-TB Gold In-Tube (QFT-GIT) testing for TST-positive referrals. We evaluated costs and cost-effectiveness of this new diagnostic algorithm.Methods: A decision-analysis model compared the strategy of treating all TST-positive referrals versus only those with positive results on adjunctive QFT-GIT testing. Costs were collected at BCHD, and Incremental Cost-Effectiveness Ratios (ICERs) were utilized to report on cost-effectiveness.Results: QFT-GIT testing at BCHD cost Gietz D.*St43.51 per test. Implementation of QFT-GIT testing was associated with an ICER of Gietz D.*St1,202 per quality-adjusted life-year gained and was considered highly cost-effective. In sensitivity analysis, the QFT-GIT strategy became cost-saving if QFT-GIT sensitivity increased above 92% or if less than 3.5% of individuals with LTBI progress to active TB disease.Conclusions: LTBI screening with TST in low-prevalence settings may lead to overtreatment and increased expenditures. In this public health clinic, additional QFT-GIT testing of individuals referred for a positive TST was cost-effective.
AB - Background: The tuberculin skin test (TST) has limitations for latent tuberculosis infection (LTBI) diagnosis in low-prevalence settings. Previously, all TST-positive individuals referred from the community to Baltimore City Health Department (BCHD) were offered LTBI treatment, after active TB was excluded. In 2010, BCHD introduced adjunctive QuantiFERON-TB Gold In-Tube (QFT-GIT) testing for TST-positive referrals. We evaluated costs and cost-effectiveness of this new diagnostic algorithm.Methods: A decision-analysis model compared the strategy of treating all TST-positive referrals versus only those with positive results on adjunctive QFT-GIT testing. Costs were collected at BCHD, and Incremental Cost-Effectiveness Ratios (ICERs) were utilized to report on cost-effectiveness.Results: QFT-GIT testing at BCHD cost Gietz D.*St43.51 per test. Implementation of QFT-GIT testing was associated with an ICER of Gietz D.*St1,202 per quality-adjusted life-year gained and was considered highly cost-effective. In sensitivity analysis, the QFT-GIT strategy became cost-saving if QFT-GIT sensitivity increased above 92% or if less than 3.5% of individuals with LTBI progress to active TB disease.Conclusions: LTBI screening with TST in low-prevalence settings may lead to overtreatment and increased expenditures. In this public health clinic, additional QFT-GIT testing of individuals referred for a positive TST was cost-effective.
KW - Diagnosis
KW - Implementation
KW - Interferon-gamma release assay
KW - Latent tuberculosis
KW - Tuberculosis
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U2 - 10.1186/1471-2334-12-360
DO - 10.1186/1471-2334-12-360
M3 - Article
C2 - 23253780
AN - SCOPUS:84871174527
SN - 1471-2334
VL - 12
JO - BMC infectious diseases
JF - BMC infectious diseases
M1 - 360
ER -