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Int J Tuberc Lung Dis. 2011 Sep;15(9):1223-30, i. doi: 10.5588/ijtld.10.0542.

Cost-effectiveness analysis of targeted and sequential screening strategies for latent tuberculosis.

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  • 1Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. james.mancuso@us.army.mil

Abstract

SETTING:

No cost-effectiveness studies of testing for latent tuberculosis infection have incorporated both targeted testing and the use of interferon-gamma release assays (IGRAs) in heterogeneous populations.

OBJECTIVE:

To examine the cost-effectiveness of universal vs. targeted and sequential testing strategies and the use of tuberculin skin testing (TST) vs. IGRAs.

DESIGN:

Using a decision-analytic model, incremental cost-effectiveness ratios were calculated in 2009 among nine potential strategies for screening recruits. A societal perspective was taken over a 20-year analytic horizon, discounting future costs at 3% annually. Sensitivity analyses were conducted to determine how changes in assumptions affected the estimates.

RESULTS:

Targeted strategies cost over US$250 000 per case prevented, whereas universal testing strategies cost over US$700 000 per incremental case prevented in base case and most sensitivity analyses.

CONCLUSION:

Targeted testing offered the best value in this population, although it was still relatively expensive compared to no testing. Sequential testing with both TST and IGRAs provided a poor incremental value compared to targeted and universal testing strategies. Targeted testing using TST was slightly more cost-effective than targeted testing using either QuantiFERON®-TB Gold In-Tube or T-SPOT®.TB, but these estimates were very sensitive to changes in model assumptions.

PMID:
21943850
[PubMed - indexed for MEDLINE]
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