title: Cost-effectiveness of different screening strategies (single or dual) for the diagnosis of tuberculosis infection in healthcare workers.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of a dual strategy of tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT-G) for screening of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) and, as a secondary objective, to study relationships between TST results, QFT-G results, and sociodemographic factors.
  
  
  METHODS
  Cross-sectional prospective study.
  
  
  METHODS
  University hospital in Madrid.
  
  
  METHODS
  A total of 103 HCWs.
  
  
  METHODS
  QFT-G was requested for all positive TST results; QFT-G results were compared with TST results, and their relationships with sociodemographic factors were analyzed. A cost-effectiveness analysis was conducted for the dual strategy (TST/QFT-G) and for TST or QFT alone, taking into account the indication of and compliance with isoniazid, the risk of hepatotoxicity, and postexposure tuberculosis.
  
  
  RESULTS
  Of all HCWs studied, 42.3% showed a positive result by QFT-G, and 49.5% had received bacille Calmette-Guérin (BCG) vaccination; no significant association was detected between BCG and QFT-G results. Increased TST was linked to higher positive QFT-G values (TST of 5-9.9 mm, 27.6%; TST of 15 mm or more, 56.5%; P=.03). The probability of positive QFT-G results was 1.04 times higher for each year of age (odds ratio, 1.04 [95% confidence interval, 1.01-1.09]; P=.0257). The incremental cost per active TB case prevented was lower for TST/QFT-G than for the other strategies studied (€14,211 per 1,000 HCWs). The number of people treated for LTBI per case of active TB prevented (number needed to treat) for TST/QFT-G was lower than for TST alone (17.2 vs 95.3 and 88.7 with the 5- and 10-mm cutoff value, respectively) or QFT-G alone (69.6).
  
  
  CONCLUSIONS
  Dual strategy with TST/QFT-G is more cost-effective than TST or QFT-G alone for the diagnosis of LTBI in HCWs.
authors.affiliation: Department of Occupational Health and Prevention, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain. tcampo@fjd.es
authors.forename: M Teresa
authors.initials: MT
authors.lastname: del Campo
authors.forename: Hadia
authors.initials: H
authors.lastname: Fouad
authors.forename: M Marcela
authors.initials: MM
authors.lastname: Solís-Bravo
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Sánchez-Uriz
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahíllo-Fernández
authors.forename: Jaime
authors.initials: J
authors.lastname: Esteban
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003663:Decision Trees; D005260:Female; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000191:economics*; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000191:economics*; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000191:economics*; D016017:Odds Ratio; D013030:Spain; D014374:Tuberculin Test / Q000191:economics*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D055815:Young Adult