Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis

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dc.contributor.authorPooran, Anilen_ZA
dc.contributor.authorBooth, Helenen_ZA
dc.contributor.authorMiller, Robert Fen_ZA
dc.contributor.authorScott, Geoffen_ZA
dc.contributor.authorBadri, Motasimen_ZA
dc.contributor.authorHuggett, Jim Fen_ZA
dc.contributor.authorRook, Grahamen_ZA
dc.contributor.authorZumla, Alimuddinen_ZA
dc.contributor.authorDheda, Keertanen_ZA
dc.date.accessioned2015-11-11T11:53:38Z
dc.date.available2015-11-11T11:53:38Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND: Previous health economic studies recommend either a dual screening strategy [tuberculin skin test (TST) followed by interferon-gamma-release assay (IGRA)] or a single one [IGRA only] for latent tuberculosis infection (LTBI), the former largely based on claims that it is more cost-effective. We sought to examine that conclusion through the use of a model that accounts for the additional costs of adverse drug reactions and directly compares two commercially available versions of the IGRA: the Quantiferon-TB-Gold-In-Tube (QFT-GIT) and T-SPOT.TB. METHODS: A LTBI screening model directed at screening contacts was used to perform a cost-effectiveness analysis, from a UK healthcare perspective, taking into account the risk of isoniazid-related hepatotoxicity and post-exposure TB (2 years post contact) using the TST, QFT-GIT and T-SPOT.TB IGRAs. RESULTS: Examining costs alone, the TST/IGRA dual screening strategies (TST/T-SPOT.TB and TST/QFT-GIT; GBP162,387 and GBP157,048 per 1000 contacts, respectively) cost less than their single strategy counterparts (T-SPOT.TB and QFT-GIT; GBP203,983 and GBP202,921 per 1000 contacts) which have higher IGRA test costs and greater numbers of persons undergoing LTBI treatment. However, IGRA alone strategies direct healthcare interventions and costs more accurately to those that are truly infected.Subsequently, less contacts need to be treated to prevent an active case of TB (T-SPOT.TB and QFT-GIT; 61.7 and 69.7 contacts) in IGRA alone strategies. IGRA single strategies also prevent more cases of post-exposure TB. However, this greater effectiveness does not outweigh the lower incremental costs associated with the dual strategies. Consequently, when these costs are combined with effectiveness, the IGRA dual strategies are more cost-effective than their single strategy counterparts. Comparing between the IGRAs, T-SPOT.TB-based strategies (single and dual; GBP39,712 and GBP37,206 per active TB case prevented, respectively) were more cost-effective than the QFT-GIT-based strategies (single and dual; GBP42,051 and GBP37,699 per active TB case prevented, respectively). Using the TST alone was the least cost-effective (GBP47,840 per active TB case prevented). Cost effectiveness values were sensitive to changes in LTBI prevalence, IGRA test sensitivities/specificities and IGRA test costs. CONCLUSION: A dual strategy is more cost effective than a single strategy but this conclusion is sensitive to screening test assumptions and LTBI prevalence.en_ZA
dc.identifier.apacitationPooran, A., Booth, H., Miller, R. F., Scott, G., Badri, M., Huggett, J. F., ... Dheda, K. (2010). Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis. <i>BMC Pulmonary Medicine</i>, http://hdl.handle.net/11427/14858en_ZA
dc.identifier.chicagocitationPooran, Anil, Helen Booth, Robert F Miller, Geoff Scott, Motasim Badri, Jim F Huggett, Graham Rook, Alimuddin Zumla, and Keertan Dheda "Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis." <i>BMC Pulmonary Medicine</i> (2010) http://hdl.handle.net/11427/14858en_ZA
dc.identifier.citationPooran, A., Booth, H., Miller, R. F., Scott, G., Badri, M., Huggett, J. F., ... & Dheda, K. (2010). Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis. BMC pulmonary medicine, 10(1), 7.en_ZA
dc.identifier.ris TY - Journal Article AU - Pooran, Anil AU - Booth, Helen AU - Miller, Robert F AU - Scott, Geoff AU - Badri, Motasim AU - Huggett, Jim F AU - Rook, Graham AU - Zumla, Alimuddin AU - Dheda, Keertan AB - BACKGROUND: Previous health economic studies recommend either a dual screening strategy [tuberculin skin test (TST) followed by interferon-gamma-release assay (IGRA)] or a single one [IGRA only] for latent tuberculosis infection (LTBI), the former largely based on claims that it is more cost-effective. We sought to examine that conclusion through the use of a model that accounts for the additional costs of adverse drug reactions and directly compares two commercially available versions of the IGRA: the Quantiferon-TB-Gold-In-Tube (QFT-GIT) and T-SPOT.TB. METHODS: A LTBI screening model directed at screening contacts was used to perform a cost-effectiveness analysis, from a UK healthcare perspective, taking into account the risk of isoniazid-related hepatotoxicity and post-exposure TB (2 years post contact) using the TST, QFT-GIT and T-SPOT.TB IGRAs. RESULTS: Examining costs alone, the TST/IGRA dual screening strategies (TST/T-SPOT.TB and TST/QFT-GIT; GBP162,387 and GBP157,048 per 1000 contacts, respectively) cost less than their single strategy counterparts (T-SPOT.TB and QFT-GIT; GBP203,983 and GBP202,921 per 1000 contacts) which have higher IGRA test costs and greater numbers of persons undergoing LTBI treatment. However, IGRA alone strategies direct healthcare interventions and costs more accurately to those that are truly infected.Subsequently, less contacts need to be treated to prevent an active case of TB (T-SPOT.TB and QFT-GIT; 61.7 and 69.7 contacts) in IGRA alone strategies. IGRA single strategies also prevent more cases of post-exposure TB. However, this greater effectiveness does not outweigh the lower incremental costs associated with the dual strategies. Consequently, when these costs are combined with effectiveness, the IGRA dual strategies are more cost-effective than their single strategy counterparts. Comparing between the IGRAs, T-SPOT.TB-based strategies (single and dual; GBP39,712 and GBP37,206 per active TB case prevented, respectively) were more cost-effective than the QFT-GIT-based strategies (single and dual; GBP42,051 and GBP37,699 per active TB case prevented, respectively). Using the TST alone was the least cost-effective (GBP47,840 per active TB case prevented). Cost effectiveness values were sensitive to changes in LTBI prevalence, IGRA test sensitivities/specificities and IGRA test costs. CONCLUSION: A dual strategy is more cost effective than a single strategy but this conclusion is sensitive to screening test assumptions and LTBI prevalence. DA - 2010 DB - OpenUCT DO - 10.1186/1471-2466-10-7 DP - University of Cape Town J1 - BMC Pulmonary Medicine LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis TI - Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis UR - http://hdl.handle.net/11427/14858 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14858
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2466-10-7
dc.identifier.vancouvercitationPooran A, Booth H, Miller RF, Scott G, Badri M, Huggett JF, et al. Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis. BMC Pulmonary Medicine. 2010; http://hdl.handle.net/11427/14858.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDivision of Pulmonologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2010 Pooran et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Pulmonary Medicineen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpulmmed/en_ZA
dc.subject.otherActive Tb Caseen_ZA
dc.subject.otherLTBI Treatmenten_ZA
dc.subject.otherQFT-GIT Testen_ZA
dc.subject.otherIGRA Testen_ZA
dc.subject.otherTST Specificityen_ZA
dc.subject.otherIncremental Net Monetary Benefiten_ZA
dc.subject.otherLatent Tuberculosis Infectionen_ZA
dc.titleDifferent screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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