QuantiFERON-TB gold in-tube implementation for latent tuberculosis diagnosis in a public health clinic: a cost-effectiveness analysis

BMC Infectious Diseases

Research Article

Maria Martins-Evora¹  Vincent Marsiglia¹  Howard Choi²  Kathryn Miele²  Susan Dorman²  Maunank Shah³  Danielle DiPietro⁴ 

[1] Baltimore City Health Department, Baltimore, MD, USA;Johns Hopkins University School of Medicine, Baltimore, MD, USA;Johns Hopkins University School of Medicine, Baltimore, MD, USA;Division of Infectious Disease, Center for TB Research, Johns Hopkins University, School of Medicine, 1503 East Jefferson St, Room 118, 21231, Baltimore, MD, USA;Tulane University, New Orleans, LA, USA;

关键词: Tuberculosis;    Diagnosis;    Interferon-gamma release assay;    Latent tuberculosis;    Implementation;   

DOI  :  10.1186/1471-2334-12-360

 received in 2012-08-14, accepted in 2012-12-14,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsA 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.ResultsQFT-GIT testing at BCHD cost $43.51 per test. Implementation of QFT-GIT testing was associated with an ICER of $1,202 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.ConclusionsLTBI 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.

【 授权许可】

CC BY   
© Shah et al.; licensee BioMed Central Ltd. 2012