Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil.
Latent tuberculosis infection (LTBI) is a reservoir for new TB cases. Isoniazid preventive therapy (IPT) reduces the risk of active TB by as much as 90%, but LTBI screening has limitations. Unlike tuberculin skin testing (TST), interferon-gamma release assays are not affected by BCG vaccination, and...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3617186?pdf=render |
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| author | Ricardo Ewbank Steffen Rosângela Caetano Márcia Pinto Diogo Chaves Rossini Ferrari Mayara Bastos Sandra Teixeira de Abreu Dick Menzies Anete Trajman |
| author_facet | Ricardo Ewbank Steffen Rosângela Caetano Márcia Pinto Diogo Chaves Rossini Ferrari Mayara Bastos Sandra Teixeira de Abreu Dick Menzies Anete Trajman |
| author_sort | Ricardo Ewbank Steffen |
| collection | DOAJ |
| description | Latent tuberculosis infection (LTBI) is a reservoir for new TB cases. Isoniazid preventive therapy (IPT) reduces the risk of active TB by as much as 90%, but LTBI screening has limitations. Unlike tuberculin skin testing (TST), interferon-gamma release assays are not affected by BCG vaccination, and have been reported to be cost-effective in low-burden countries. The goal of this study was to perform a cost-effectiveness analysis from the health system perspective, comparing three strategies for LTBI diagnosis in TB contacts: tuberculin skin testing (TST), QuantiFERON®-TB Gold-in-Tube (QFT-GIT) and TST confirmed by QFT-GIT if positive (TST/QFT-GIT) in Brazil, a middle-income, high-burden country with universal BCG coverage.Costs for LTBI diagnosis and treatment of a hypothetical cohort of 1,000 adult immunocompetent close contacts were considered. The effectiveness measure employed was the number of averted TB cases in two years. Health system costs were US$ 105,096 for TST, US$ 121,054 for QFT-GIT and US$ 101,948 for TST/QFT-GIT; these strategies averted 6.56, 6.63 and 4.59 TB cases, respectively. The most cost-effective strategy was TST (US$ 16,021/averted case). The incremental cost-effectiveness ratio was US$ 227,977/averted TB case for QFT-GIT. TST/QFT-GIT was dominated.Unlike previous studies, TST was the most cost-effective strategy for averting new TB cases in the short term. QFT-GIT would be more cost-effective if its costs could be reduced to US$ 26.95, considering a TST specificity of 59% and US$ 18 considering a more realistic TST specificity of 80%. Nevertheless, with TST, 207.4 additional people per 1,000 will be prescribed IPT compared with QFT. |
| first_indexed | 2024-12-13T04:38:44Z |
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| id | doaj.art-cf4b886aa43e4e8f8f4c537ba30687d5 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-13T04:38:44Z |
| publishDate | 2013-01-01 |
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| spelling | doaj.art-cf4b886aa43e4e8f8f4c537ba30687d52022-12-21T23:59:23ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0184e5954610.1371/journal.pone.0059546Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil.Ricardo Ewbank SteffenRosângela CaetanoMárcia PintoDiogo ChavesRossini FerrariMayara BastosSandra Teixeira de AbreuDick MenziesAnete TrajmanLatent tuberculosis infection (LTBI) is a reservoir for new TB cases. Isoniazid preventive therapy (IPT) reduces the risk of active TB by as much as 90%, but LTBI screening has limitations. Unlike tuberculin skin testing (TST), interferon-gamma release assays are not affected by BCG vaccination, and have been reported to be cost-effective in low-burden countries. The goal of this study was to perform a cost-effectiveness analysis from the health system perspective, comparing three strategies for LTBI diagnosis in TB contacts: tuberculin skin testing (TST), QuantiFERON®-TB Gold-in-Tube (QFT-GIT) and TST confirmed by QFT-GIT if positive (TST/QFT-GIT) in Brazil, a middle-income, high-burden country with universal BCG coverage.Costs for LTBI diagnosis and treatment of a hypothetical cohort of 1,000 adult immunocompetent close contacts were considered. The effectiveness measure employed was the number of averted TB cases in two years. Health system costs were US$ 105,096 for TST, US$ 121,054 for QFT-GIT and US$ 101,948 for TST/QFT-GIT; these strategies averted 6.56, 6.63 and 4.59 TB cases, respectively. The most cost-effective strategy was TST (US$ 16,021/averted case). The incremental cost-effectiveness ratio was US$ 227,977/averted TB case for QFT-GIT. TST/QFT-GIT was dominated.Unlike previous studies, TST was the most cost-effective strategy for averting new TB cases in the short term. QFT-GIT would be more cost-effective if its costs could be reduced to US$ 26.95, considering a TST specificity of 59% and US$ 18 considering a more realistic TST specificity of 80%. Nevertheless, with TST, 207.4 additional people per 1,000 will be prescribed IPT compared with QFT.http://europepmc.org/articles/PMC3617186?pdf=render |
| spellingShingle | Ricardo Ewbank Steffen Rosângela Caetano Márcia Pinto Diogo Chaves Rossini Ferrari Mayara Bastos Sandra Teixeira de Abreu Dick Menzies Anete Trajman Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil. PLoS ONE |
| title | Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil. |
| title_full | Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil. |
| title_fullStr | Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil. |
| title_full_unstemmed | Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil. |
| title_short | Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil. |
| title_sort | cost effectiveness of quantiferon r tb gold in tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in brazil |
| url | http://europepmc.org/articles/PMC3617186?pdf=render |
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