Cost-optimisation of screening for latent tuberculosis in close contacts.
The aim of the present study was to perform cost-minimisation analysis of contact investigation from a public health perspective using the tuberculin skin test (TST) and a new blood assay, QuantiFERON-TB Gold (QFT-G). A decision-analysis model simulated the costs of investigating a cohort of adult close tuberculosis contacts by the public health service following the current German guidelines over a period of 2 yrs. The economic outcomes were compared with alternative screening strategies. These were: 1) QFT-G instead of TST; 2) TST followed by QFT-G; and 3) TST followed by QFT-G in vaccinated (bacille Calmette-Guérin (BCG)) subjects. In a base-case analysis, the costs of TST-based screening were 91.06 Euros (EUR).contact(-1), assuming a 1% tuberculosis-case-finding incidence. The least expensive strategy was TST screening plus subsequent QFT-G testing (52.05 EUR), resulting in a 43% cost reduction. Using QFT-G alone in BCG-vaccinated subjects who tested positive in the TST led to a 39% cost reduction. The savings using QFT-G alone instead of TST amounted to 29.77 EUR.contact(-1). The results depended on the acquisition costs assumed and the proportion of positive results in TST-based screening. Screening for tuberculosis by combining tuberculin skin testing and QuantiFERON-TB Gold markedly reduces public health costs compared with tuberculin skin test screening alone.
School of Public Health, c/o Institute for Medical Sociology, Heinrich Heine University, P.O. box 101007, D-40001 Düsseldorf, Germany. Roland.Diel@uni-duesseldorf.de
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Nienhaus
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D000942:Antigens, Bacterial / Q000378:metabolism; D001500:BCG Vaccine; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006403:Hematologic Tests / Q000191:economics / Q000379:methods*; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009169:Mycobacterium tuberculosis / Q000378:metabolism*; D011634:Public Health; D012680:Sensitivity and Specificity; D014374:Tuberculin Test / Q000191:economics / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics*
D000942:Antigens, Bacterial; D001500:BCG Vaccine; D007371:Interferon-gamma