title: Cost effectiveness of interferon-gamma release assay for tuberculosis screening using three months of rifapentine and isoniazid among long-term expatriates from low to high incidence countries.
abstract: BACKGROUND
  Long-term expatriates from low to high tuberculosis (TB) incidence countries get high rates of active TB and latent TB infection (LTBI). TB screening for expatriates is important for occupational health. Interferon-gamma release assays are more accurate than tuberculin skin test (TST). Rifapentine plus isoniazid for 3 months (3HP) is as effective as 9 months of isoniazid (9H) with a higher treatment-completion rate.
  
  
  METHODS
  Decision trees and Markov models were constructed using a societal perspective on a lifetime horizon. The target population was a hypothetical cohort of 30 year-old expatriates. Seven strategies; TST with 3HP or 9H, QuantiFERON®-TB Gold In-Tube (QFT) with 3HP or 9H, T-SPOT®.TB (TSPOT) with 3HP or 9H and chest X-ray examination (CXR) were modeled. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs) gained.
  
  
  RESULTS
  QFT with 3HP yielded the greatest benefits with the lowest cost ($US 674.8; 25.95660 QALYs [year 2012 values]). CXR was the least cost-effective ($US 13,666.8; 24.62917 QALYs). Cost-effectiveness was sensitive to adherence rate of 3HP and QFT specificity, but not to BCG vaccination rate.
  
  
  CONCLUSIONS
  Entry LTBI screening using QFT treated with 3HP is recommended on the basis of cost effectiveness among long-term expatriates from low to high incidence countries.
authors.affiliation: General Affairs Department, Ota City Office, Tokyo, Japan. Electronic address: kowadaa@gmail.com.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kowada
mesh_terms: D000328:Adult; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D015994:Incidence; D059425:Interferon-gamma Release Tests / Q000191:economics*; D007538:Isoniazid / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000382:microbiology / Q000635:transmission; D008297:Male; D008390:Markov Chains; D008403:Mass Screening; D012293:Rifampin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014195:Travel
chemical_list: D007538:Isoniazid; D012293:Rifampin; C018421:rifapentine
keywords: Cost-effectiveness; Expatriate; Interferon-gamma release assay; Latent tuberculosis infection; Rifapentine