title: Cost-effectiveness of interferon-γ release assay versus chest X-ray for tuberculosis screening of employees.
abstract: BACKGROUND
  Currently, an annual chest X-ray examination (CXR) for detection of active tuberculosis (TB) in employees aged ≥40 years is recommended in the guidelines of the Japan Industrial Safety and Health Law. Interferon-γ release assays are new alternatives to the tuberculin skin test for detecting Mycobacterium tuberculosis infection, with higher specificity than the tuberculin skin test and without cross-reactivity with the Bacille Calmette-Guérin vaccine. This study aimed to assess the cost-effectiveness of employee TB screening using QuantiFERON-TB Gold In-Tube (QFT) versus CXR.
  
  
  METHODS
  Markov models were constructed. The target population was a hypothetical cohort of immunocompetent 40-year-old individuals, using a societal perspective and a lifetime horizon. All costs and clinical benefits were discounted at a fixed annual rate of 3%.
  
  
  RESULTS
  In a base-case analysis, the QFT strategy was the most cost-effective ($US 262.84; 22.87049 quality-adjusted life-years [QALYs]) compared with no screening ($448.38; 22.85452 QALYs) and CXR ($543.50; 22.85453 QALYs) [year 2009 values].
  
  
  CONCLUSIONS
  The QFT strategy is currently robust for screening Bacille Calmette-Guérin- vaccinated employees in Japan. There appears to be little role for CXR. These findings may be applicable to other countries in terms of choosing optimal TB screening for employees.
authors.affiliation: Public Health Promotion Division, Tamagawa District Administration Office, City of Setagaya, Tokyo, Japan. Kowada101@mb.city.setagaya.tokyo.jp
authors.forename: Akiko
authors.initials: A
authors.lastname: Kowada
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006282:Health Personnel; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000191:economics* / Q000379:methods; D007564:Japan; D008297:Male; D016272:Occupational Health; D013902:Radiography, Thoracic / Q000191:economics* / Q000379:methods; D014376:Tuberculosis / Q000175:diagnosis*; D014965:X-Rays