OBJECTIVE: To evaluate the cost-effectiveness of the tuberculin skin test (TST), the QuantiFERON-TB Gold test (QFT) and a combination of TST and QFT (TST+QFT) for diagnosing latent tuberculosis infection (LTBI) in France in a bacille Calmette-Guérin (BCG) vaccinated population. METHODS: A decision analysis model evaluated three strategies among simulated adults in close contact with tuberculosis (TB). We calculated direct lifetime medical costs, life expectancies and incremental cost-effectiveness ratios (ICERs). RESULTS: The discounted direct medical costs of care per patient of no testing, TST, QFT and TST+QFT were respectively euro417, euro476, euro443 and euro435, while discounted life expectancies were respectively 25.030, 25.071, 25.073 and 25.062 years. TST had higher costs and lower efficacy than QFT; TST+QFT was associated with an ICER of euro560 per year of life gained (YLG) compared to no testing, and QFT was associated with an ICER of euro730/YLG compared to TST+QFT. The only scenario where QFT was associated with an ICER of >euro75 000/YLG was when the prevalence of LTBI around TB was low (<5%) and TST specificity high (>90%). CONCLUSIONS: In France, for the diagnosis of LTBI after close contact with TB, the TST is more expensive and less effective than QFT. Although it is more expensive, QFT is more effective and cost-effective than TST+QFT under a wide range of realistic test performance scenarios.
OBJECTIVE: To evaluate the cost-effectiveness of the tuberculin skin test (TST), the QuantiFERON-TB Gold test (QFT) and a combination of TST and QFT (TST+QFT) for diagnosing latent tuberculosis infection (LTBI) in France in a bacille Calmette-Guérin (BCG) vaccinated population. METHODS: A decision analysis model evaluated three strategies among simulated adults in close contact with tuberculosis (TB). We calculated direct lifetime medical costs, life expectancies and incremental cost-effectiveness ratios (ICERs). RESULTS: The discounted direct medical costs of care per patient of no testing, TST, QFT and TST+QFT were respectively euro417, euro476, euro443 and euro435, while discounted life expectancies were respectively 25.030, 25.071, 25.073 and 25.062 years. TST had higher costs and lower efficacy than QFT; TST+QFT was associated with an ICER of euro560 per year of life gained (YLG) compared to no testing, and QFT was associated with an ICER of euro730/YLG compared to TST+QFT. The only scenario where QFT was associated with an ICER of >euro75 000/YLG was when the prevalence of LTBI around TB was low (<5%) and TST specificity high (>90%). CONCLUSIONS: In France, for the diagnosis of LTBI after close contact with TB, the TST is more expensive and less effective than QFT. Although it is more expensive, QFT is more effective and cost-effective than TST+QFT under a wide range of realistic test performance scenarios.
Authors: Abriana Tasillo; Joshua A Salomon; Thomas A Trikalinos; C Robert Horsburgh; Suzanne M Marks; Benjamin P Linas Journal: JAMA Intern Med Date: 2017-12-01 Impact factor: 44.409
Authors: Haileyesus Getahun; Alberto Matteelli; Ibrahim Abubakar; Mohamed Abdel Aziz; Annabel Baddeley; Draurio Barreira; Saskia Den Boon; Susana Marta Borroto Gutierrez; Judith Bruchfeld; Erlina Burhan; Solange Cavalcante; Rolando Cedillos; Richard Chaisson; Cynthia Bin-Eng Chee; Lucy Chesire; Elizabeth Corbett; Masoud Dara; Justin Denholm; Gerard de Vries; Dennis Falzon; Nathan Ford; Margaret Gale-Rowe; Chris Gilpin; Enrico Girardi; Un-Yeong Go; Darshini Govindasamy; Alison D Grant; Malgorzata Grzemska; Ross Harris; C Robert Horsburgh; Asker Ismayilov; Ernesto Jaramillo; Sandra Kik; Katharina Kranzer; Christian Lienhardt; Philip LoBue; Knut Lönnroth; Guy Marks; Dick Menzies; Giovanni Battista Migliori; Davide Mosca; Ya Diul Mukadi; Alwyn Mwinga; Lisa Nelson; Nobuyuki Nishikiori; Anouk Oordt-Speets; Molebogeng Xheedha Rangaka; Andreas Reis; Lisa Rotz; Andreas Sandgren; Monica Sañé Schepisi; Holger J Schünemann; Surender Kumar Sharma; Giovanni Sotgiu; Helen R Stagg; Timothy R Sterling; Tamara Tayeb; Mukund Uplekar; Marieke J van der Werf; Wim Vandevelde; Femke van Kessel; Anna van't Hoog; Jay K Varma; Natalia Vezhnina; Constantia Voniatis; Marije Vonk Noordegraaf-Schouten; Diana Weil; Karin Weyer; Robert John Wilkinson; Takashi Yoshiyama; Jean Pierre Zellweger; Mario Raviglione Journal: Eur Respir J Date: 2015-09-24 Impact factor: 16.671