Targeted screening and treatment for latent tuberculosis infection using QuantiFERON-TB Gold is cost-effective in Mexico.
OBJECTIVE
To assess the cost-effectiveness of screening for latent tuberculosis infection (LTBI) using a commercially available detection test and treating individuals at high risk for human immunodeficiency virus (HIV) infection in a middle-income country.


METHODS
We developed a Markov model to evaluate the cost per LTBI case detected, TB case averted and quality-adjusted life year (QALY) gained for a cohort of 1000 individuals at high risk for HIV infection over 20 years. Baseline model inputs for LTBI prevalence were obtained from published literature and cross-sectional data from tuberculosis (TB) screening using QuantiFERON-TB Gold In-Tube (QFT-GIT) testing among sex workers and illicit drug users at high risk for HIV recruited through street outreach in Tijuana, Mexico. Costs are reported in 2007 US dollars. Future costs and QALYs were discounted at 3% per year. Sensitivity analyses were performed to evaluate model robustness.


RESULTS
Over 20 years, we estimate the program would prevent 78 cases of active TB and 55 TB-related deaths. The incremental cost per case of LTBI detected was US$730, cost per active TB averted was US$529 and cost per QALY gained was US$108.


CONCLUSIONS
In settings of endemic TB and escalating HIV incidence, targeting LTBI screening and treatment among high-risk groups may be highly cost-effective.
Burgos
J L
JL
Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, California 92093-0507, USA. jlburgos@ucsd.edu
Kahn
J G
JG
Strathdee
S A
SA
Valencia-Mendoza
A
A
Bautista-Arredondo
S
S
Laniado-Laborin
R
R
Castañeda
R
R
Deiss
R
R
Garfein
R S
RS
D015897:Comorbidity; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008800:Mexico / Q000453:epidemiology; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000628:therapy*