Cost-effectiveness of interferon-gamma release assay testing for the treatment of latent tuberculosis.
The aim of the present study was to assess the cost-effectiveness of the new T-SPOT.TB assay versus the tuberculin skin test (TST) for screening contacts for latent tuberculosis (TB) infection in Switzerland. Health and economic outcomes of isoniazid treatment of 20- and 40-yr-old close contacts were compared in a Markov model over a 20-yr period following screening with TST only (at three cut-off values) and T-SPOT.TB alone or in combination with the TST. T-SPOT.TB-based treatment was cost-effective at (Euro)11,621 and (Euro)23,692 per life-year-gained (LYG) in the younger and older age group, respectively. No TST-based programmes were cost-effective, except at a 15-mm cut-off in the younger group only, where the cost-effectiveness ((Euro)26,451.LYG(-1)) fell just below the willingness-to-pay threshold. Combination of the TST with T-SPOT.TB slightly reduced the total cost compared with the T-SPOT.TB alone by 4.4 and 5.0% in the younger and older groups respectively. The number of contacts treated to avoid one case of TB decreased from 50 (95% confidence interval 32-106) with the TST (10-mm cut-off) to 18 (95%CI 11-43) if T-SPOT.TB was used. Using T-SPOT.TB alone or in combination with the tuberculin skin test for screening of close contacts before latent tuberculosis infection treatment is highly cost-effective in reducing the disease burden of tuberculosis.
Diel
R
R
School of Public Health, University of Düsseldorf, Germany. Roland.Diel@uni-duesseldorf.de
Wrighton-Smith
P
P
Zellweger
J-P
JP
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002353:Carrier State; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D011336:Probability; D012680:Sensitivity and Specificity; D012984:Software; D013557:Switzerland / Q000453:epidemiology; D014374:Tuberculin Test / Q000191:economics* / Q000379:methods; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents; D007371:Interferon-gamma