title: Cost-effectiveness of interferon-gamma release assay for entry tuberculosis screening in prisons.
abstract: The incidence of active tuberculosis (TB) and latent tuberculosis infection (LTBI) in inmates and prison staff is higher than that in the general population. Mycobacterium tuberculosis-specific interferon-gamma release assays (IGRAs) provide more accurate diagnosis of M. tuberculosis infection with higher specificity than the tuberculin skin test (TST). To assess the cost effectiveness of QuantiFERON®-TB Gold In-Tube (QFT) compared to TST, TST followed by QFT and chest X-ray, we constructed Markov models using a societal perspective on the lifetime horizon. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness was compared. The QFT-alone strategy was the most cost-effective for entry TB screening in prisons in developed countries. Cost-effectiveness was not sensitive to the rates of BCG vaccination, LTBI, TB, HIV infection and multidrug-resistant TB. Entry TB screening using an IGRA in prisons should be considered on the basis of its cost-effectiveness by public health intervention.
authors.affiliation: Kojiya Haneda Healthcare Service, Ota City Public Health Office, Tokyo, Japan. kowadaa@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Kowada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000191:economics* / Q000706:statistics & numerical data*; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D011330:Prisons / Q000706:statistics & numerical data*; D011634:Public Health; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics*