title: Cost-effectiveness of interferon-gamma release assays for tuberculosis screening in nursing homes.
abstract: Tuberculosis (TB) in older people is a significant public health problem in low TB-incidence countries. Older persons have increased TB incidence, higher reactivation and mortality. A delay in diagnosis and initiation of TB treatment in patients with atypical clinical and radiological features is a significant factor of widespread transmission. This study aimed to evaluate the cost-effectiveness of interferon-gamma release assays [IGRAs; QuantiFERON®-TB Gold In-Tube (QFT) and T-SPOT®.TB (T-SPOT)] compared to the tuberculin skin test (TST) and chest X-ray (CXR) examination for TB screening for nursing homes. Decision trees and Markov models were constructed using a societal perspective on a lifetime horizon. Seven strategies: no screening, TST, QFT, T-SPOT, TST followed by QFT, TST followed by T-SPOT, and CXR were considered. QFT [US$ 401·9, 4·36 707 QALY (year 2014 values)] was the most cost-effective at the willingness-to-pay level of US$ 50 000/QALY gained. TST followed by QFT was the most cost-effective in residents with comorbidities. CXR was less cost-effective. Cost-effectiveness was sensitive to latent TB infection (LTBI) rate and bacillus Calmette-Guérin vaccination rate. Effective LTBI screening using IGRA is recommended to prevent TB transmission not only in nursing homes but also in local communities in low-incidence countries.
authors.affiliation: General Affairs Department,Ota City Office,Tokyo,Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kowada
mesh_terms: D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000191:economics / Q000379:methods*; D008168:Lung / Q000000981:diagnostic imaging*; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D009735:Nursing Homes; D013902:Radiography, Thoracic / Q000191:economics / Q000379:methods; D014374:Tuberculin Test / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging
keywords: Cost-effectiveness study; public health; screening programme; transmission; tuberculosis (TB)