Romain Freund1, Benjamin Granger2, Cécile Francois3, Guislaine Carcelain4, Philippe Ravaud5, Xavier Mariette6, Bruno Fautrel7. 1. Pierre et Marie Curie university-Paris 6, Sorbonne universités, GRC-08 (EEMOIS), 75013 Paris, France. 2. Pierre et Marie Curie university-Paris 6, Sorbonne universités, GRC-08 (EEMOIS), 75013 Paris, France; AP-HP, Pitié-Salpêtrière hospital, department of biostatistics, public health and medical information (BIOSPIM), 75013 Paris, France. 3. AP-HP, Pitié-Salpêtrière hospital, department of biostatistics, public health and medical information (BIOSPIM), 75013 Paris, France. 4. Sorbonne universités, UPMC université Paris 06, Inserm, centre d'immunologie et des maladies infectieuses (CIMI-Paris), UMR 1135, ERL CNRS 8255, 91, boulevard de l'hôpital, 75013 Paris, France; Assistance Publique-Hôpitaux de Paris, departement d'immunologie, CHU Pitié-Salpêtrière, 47-83, boulevard de l'hôpital, 75013 Paris, France. 5. AP-HP, epidemiology center, Hotel-Dieu, 75004 Paris, France; René Descartes university, inserm, UMR 1153, Hotel-Dieu, 75181 Paris cedex, France. 6. AP-HP, Bicêtre hospital, université Paris-Sud, department of rheumatology, 94270 Le Kremlin Bicêtre, France; CRI-IMIDIATE clinical research network, 75013, Paris, France. 7. Pierre et Marie Curie university-Paris 6, Sorbonne universités, GRC-08 (EEMOIS), 75013 Paris, France; CRI-IMIDIATE clinical research network, 75013, Paris, France; AP-HP, Pitié-Salpêtrière hospital, rheumatology department, 75013 Paris, France. Electronic address: bruno.fautrel@aphp.fr.
Abstract
Several tests have been proposed to detect latent tuberculosis (LTB). OBJECTIVE: To evaluate the cost-effectiveness of different interferon-gamma release assays based strategies used to screen LTB before tumour necrosis factor (TNF) blockers initiation. METHODS: Consecutive patients with rheumatoid arthritis, spondyloarthritis or Crohn's disease for whom TNF-blockers were considered, were recruited in 15 tertiary care centres. All were screened for LTB with tuberculin skin test (TST), QuantiFERON TB Gold® in tube (QFT) and T-SPOT.TB® (TSpot) on the same day. Cost-minimization and cost-effectiveness analysis, testing 8 screening test combinations, were conducted. Effectiveness was defined as the percentage of LTB treatment avoided and compared with TST alone. Cost were elicited in the payer perspective, included all the costs related to the screening procedure. RESULTS: No tuberculosis reactivation was observed after TNF-blocker initiation. TST followed by QFT if TST was positive was found as the best screening strategy, i.e. the less costly (-54€ compared to reference) and most effective (effectiveness 0.93), resulting in an incremental cost-effectiveness ratio of -192€ per treatment avoided. A probabilistic sensitivity analysis confirmed this result in 72.3% of simulations. CONCLUSION: TST followed by QFT if TST was positive is the most cost-effective strategy in screening for LTB in patients before starting anti-TNF therapy. TRIALREGNO: NCT00811343.
Several tests have been proposed to detect latent tuberculosis (LTB). OBJECTIVE: To evaluate the cost-effectiveness of different interferon-gamma release assays based strategies used to screen LTB before tumour necrosis factor (TNF) blockers initiation. METHODS: Consecutive patients with rheumatoid arthritis, spondyloarthritis or Crohn's disease for whom TNF-blockers were considered, were recruited in 15 tertiary care centres. All were screened for LTB with tuberculin skin test (TST), QuantiFERON TB Gold® in tube (QFT) and T-SPOT.TB® (TSpot) on the same day. Cost-minimization and cost-effectiveness analysis, testing 8 screening test combinations, were conducted. Effectiveness was defined as the percentage of LTB treatment avoided and compared with TST alone. Cost were elicited in the payer perspective, included all the costs related to the screening procedure. RESULTS: No tuberculosis reactivation was observed after TNF-blocker initiation. TST followed by QFT if TST was positive was found as the best screening strategy, i.e. the less costly (-54€ compared to reference) and most effective (effectiveness 0.93), resulting in an incremental cost-effectiveness ratio of -192€ per treatment avoided. A probabilistic sensitivity analysis confirmed this result in 72.3% of simulations. CONCLUSION: TST followed by QFT if TST was positive is the most cost-effective strategy in screening for LTB in patients before starting anti-TNF therapy. TRIALREGNO: NCT00811343.