title: Decreasing cost effectiveness of testing for latent TB in HIV in a low TB incidence area.
abstract: Testing for latent tuberculosis infection (LTBI) in HIV-infected persons in low tuberculosis (TB) incidence areas is often recommended. Using contemporary, clinical data, we report the yield and cost-effectiveness of testing all HIV attendees, two current UK strategies and no LTBI testing. Economic modelling was performed utilising 10-year follow up data from a large HIV clinical cohort. Outcomes were numbers of cases of active TB and incremental cost per quality-adjusted life year (QALY) gained. Between 2000 and 2010, 256 people were treated for TB/HIV co-infection. 72 (28%) occurred ≥3 months after HIV diagnosis and may have been prevented by LTBI testing. Between 2000 and 2005, the incremental cost per QALY gained for the British HIV Association (BHIVA) and UK National Institute of Care Excellence (NICE) strategies, and testing all clinic attendees was €6270, €6998 and €33,473, respectively. These rose to €9332, €32,564 and €74,067, respectively, between 2005 and 2010. Probabilistic sensitivity analysis suggested that at a threshold of €24,000 per additional QALY, the most cost-effective strategies would be NICE or testing all in 2000-2005 and BHIVA during 2005-2010. Both UK testing regimens missed cases but are cost-effective compared with no testing. Using recent data, they all became more expensive, suggesting that alternative or more targeted TB testing strategies must be considered.
authors.affiliation: Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK santino.capocci@nhs.net.
authors.forename: Santino
authors.initials: S
authors.lastname: Capocci
authors.affiliation: Department of Infection and Population Health, University College London, London, UK.
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.affiliation: Department of Applied Health Research, University College London, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.affiliation: Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhagani
authors.affiliation: Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Cropley
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK Medical Research Council Clinical Trials Unit, London, UK.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
authors.affiliation: Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of HIV and Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK Division of Medicine, University College London, London, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Lipman
mesh_terms: D000465:Algorithms; D015331:Cohort Studies; D060085:Coinfection; D003140:Communicable Disease Control / Q000191:economics*; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000191:economics*; D006801:Humans; D015994:Incidence; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000191:economics*; D008131:London; D008403:Mass Screening / Q000191:economics; D018803:Models, Economic; D015995:Prevalence; D011336:Probability; D019057:Quality-Adjusted Life Years