Display Settings:

Format

Send to:

Choose Destination
We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Am J Respir Crit Care Med. 2011 Sep 1;184(5):590-601. doi: 10.1164/rccm.201101-0181OC.

Priorities for screening and treatment of latent tuberculosis infection in the United States.

Author information

  • 1HIV Epidemiology and Outcomes Research Unit, Boston Medical Center, Section of Infectious Disease, Evans Biomedical Research Center, 650 Albany St. Rm 647, Boston, MA 02118, USA. benjamin.linas@bmc.org

Abstract

RATIONALE:

To improve the effectiveness of tuberculosis (TB) control programs in the United States by identifying cost-effective priorities for screening for latent tuberculosis infection (LTBI).

OBJECTIVES:

To estimate the cost-effectiveness of LTBI screening using the tuberculin skin test (TST)and interferon-g release assays (IGRAs).

METHODS:

A Markov model of screening for LTBI with TST and IGRA in risk-groups considered in current LTBI screening guidelines.

MEASUREMENTS AND MAIN RESULTS:

In all risk-groups, TST and IGRA screening resulted in increased mean life expectancy, ranging from 0.03–0.24 life-months per person screened. IGRA screening resulted in greater life expectancy gains than TST. Screening always cost more than not screening, but IGRA was cost-saving compared with TST in some groups. Four patterns of cost-effectiveness emerged, related to four risk categories. (1) Individuals at highest risk of TB reactivation (close contacts and those infected with HIV): the incremental cost-effectiveness ratio (ICER) of IGRA compared with TST was less than $100,000 per quality-adjusted life year (QALY) gained. (2) The foreign-born: IGRA was cost-saving compared with TST and cost-effective compared with no screening (ICER ,$100,000 per QALY gained). (3) Vulnerable populations (e.g., homeless, drug user, or former prisoner): the ICER of TST screening was approximately $100,000–$150,000 per QALY gained, but IGRA was not cost-effective. (4) Medical comorbidities (e.g., diabetes): the ICER of screening with TST or IGRA was greater than $100,000 per QALY.

CONCLUSIONS:

LTBI screening guidelines could make progress toward TB elimination by prioritizing screening for close contacts, those infected with HIV, and the foreign-born regardless of time living in the United States. For these groups, IGRA screening was more cost-effective than TST screening.

Comment in

PMID:
21562129
[PubMed - indexed for MEDLINE]
PMCID:
PMC3175546
Free PMC Article

Images from this publication.See all images (2)Free text

Figure 1.
Figure 2.
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Atypon Icon for PubMed Central
    Loading ...
    Write to the Help Desk