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Eur Respir J. 2015 Jul;46(1):165-74. doi: 10.1183/09031936.00067114. Epub 2015 Apr 16.

Decreasing cost effectiveness of testing for latent TB in HIV in a low TB incidence area.

Author information

1
Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK santino.capocci@nhs.net.
2
Department of Infection and Population Health, University College London, London, UK.
3
Department of Applied Health Research, University College London, London, UK.
4
Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK.
5
Research Department of Infection and Population Health, University College London, London, UK Medical Research Council Clinical Trials Unit, London, UK.
6
Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK.
7
Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK Division of Medicine, University College London, London, UK.

Abstract

Testing for latent tuberculosis infection (LTBI) in HIV-infected persons in low tuberculosis (TB) incidence areas is often recommended. Using contemporary, clinical data, we report the yield and cost-effectiveness of testing all HIV attendees, two current UK strategies and no LTBI testing. Economic modelling was performed utilising 10-year follow up data from a large HIV clinical cohort. Outcomes were numbers of cases of active TB and incremental cost per quality-adjusted life year (QALY) gained. Between 2000 and 2010, 256 people were treated for TB/HIV co-infection. 72 (28%) occurred ≥3 months after HIV diagnosis and may have been prevented by LTBI testing. Between 2000 and 2005, the incremental cost per QALY gained for the British HIV Association (BHIVA) and UK National Institute of Care Excellence (NICE) strategies, and testing all clinic attendees was €6270, €6998 and €33,473, respectively. These rose to €9332, €32,564 and €74,067, respectively, between 2005 and 2010. Probabilistic sensitivity analysis suggested that at a threshold of €24,000 per additional QALY, the most cost-effective strategies would be NICE or testing all in 2000-2005 and BHIVA during 2005-2010. Both UK testing regimens missed cases but are cost-effective compared with no testing. Using recent data, they all became more expensive, suggesting that alternative or more targeted TB testing strategies must be considered.

PMID:
25882810
DOI:
10.1183/09031936.00067114
[Indexed for MEDLINE]
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