title: Cost-effectiveness analysis of targeted and sequential screening strategies for latent tuberculosis.
abstract: METHODS
  No cost-effectiveness studies of testing for latent tuberculosis infection have incorporated both targeted testing and the use of interferon-gamma release assays (IGRAs) in heterogeneous populations.
  
  
  OBJECTIVE
  To examine the cost-effectiveness of universal vs. targeted  and sequential testing strategies and the use of tuberculin skin testing (TST) vs. IGRAs.
  
  
  METHODS
  Using a decision-analytic model, incremental cost-effectiveness ratios were calculated in 2009 among nine potential strategies for screening recruits. A societal perspective was taken over  a 20-year analytic horizon, discounting future costs at 3% annually. Sensitivity analyses were conducted to determine how changes in assumptions affected the estimates.
  
  
  RESULTS
  Targeted strategies cost over US$250 000 per case prevented, whereas universal testing strategies  cost over US$700 000 per incremental case prevented in base case and most sensitivity analyses.
  
  
  CONCLUSIONS
  Targeted testing offered the best value in this population, although it was still relatively expensive compared to no testing. Sequential testing with both TST and IGRAs  provided a poor incremental value compared to targeted and universal testing strategies. Targeted testing using TST was slightly more cost-effective than targeted testing using either QuantiFERON®-TB Gold In-Tube or T-SPOT®.TB, but these estimates were very sensitive to changes  in model assumptions.
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. james.mancuso@us.army.mil
authors.forename: J D
authors.initials: JD
authors.lastname: Mancuso
authors.forename: D W
authors.initials: DW
authors.lastname: Niebuhr
authors.forename: K D
authors.initials: KD
authors.lastname: Frick
authors.forename: L W
authors.initials: LW
authors.lastname: Keep
authors.forename: K M
authors.initials: KM
authors.lastname: Anderson
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000191:economics / Q000379:methods*; D055985:Latent Tuberculosis / Q000175:diagnosis*; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D018803:Models, Economic; D014374:Tuberculin Test / Q000191:economics / Q000379:methods*