Cost-effectiveness of interferon-gamma release assays for tuberculosis screening in nursing homes

Kowada, Akiko

doi:10.1017/s0950268816001382

Cited by 7 publications

(12 citation statements)

References 28 publications

(49 reference statements)

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“…When comparing the modeling results for four possible screening strategies, Li et al found that the most cost-effective strategy was LTBI/TB screening, providing the highest Life Years (LYs) and QALYs gained (8). Results from Kowada's modeling were similar, finding that the most cost-effective TB screening practice was QuantiFERON ($ 50,000 US/QALY), while TST (tuberculin skin test) followed by QFT was best for residents considered to be higher risk of TB reactivation due to comorbidities, such as HIV infection, diabetes mellitus and chronic kidney disease (9).…”

Section: Assessment Of Cxr and Other Methods To Screen For Tb In Ltcfmentioning

confidence: 92%

“…Kowada ran a similar modeling experiment in 2016 (also with a threshold for cost-effectiveness of $50,000 per QALY gained) for a hypothetical population of 84 years-old LTCF residents in Japan with previous BCG vaccination. Of seven possible screening strategies, using CXR alone was found to be the least cost-effective means to find new TB cases (9). Also in Japan, Kowada et al (10) modeled a hypothetical cohort of immunocompetent and 65 years-old people using three different strategies.…”

Section: Cost-effectiveness Of Screening Using Cxr To Find Active Tb Casesmentioning

confidence: 99%

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Review of Evidence for Using Chest X-Rays for Active Tuberculosis Screening in Long-Term Care in Canada

Herrera

Haworth‐Brockman

Keynan

2020

Front. Public Health

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Background: People living in long-term care facilities (LTCF) are at high risk to develop active tuberculosis primarily as a result of reactivation of a latent TB infection, or endemic transmission between residents. Current national guidelines in Canada are to use a posterior-anterior and lateral chest X-ray to screen for TB for those over 65 years old, upon admission to a LTCF.Objective: To assess the available evidence for cost benefits of universal chest X-ray screening for new LTCF residents.Methodology: We conducted a search for all articles published until September 2018, in PubMed and WorlCat databases, in English, using a combination of key words: chest X-ray, chest radiography or CXR, long-term care, elderly, screening, and tuberculosis. We also reviewed publicly available guidelines for screening new residents to LTCF from across Canada. We report on a qualitative synthesis of the evidence in the documents retrieved.Results: The final review yielded four cost-effectiveness studies (2 of 4 conducted in countries with low incidence), one systematic review, one recommendation/editorial, and one cohort study. We found that in a tuberculosis low-incidence country the CXR cost per identified case was $672,298 CAD. Enacting a more targeted screening program, perhaps one that tests only those who previously had TB, or other high-risk medical conditions may enhance the cost-effectiveness.Recommendations: We suggest reviewing the screening policy for active TB in people entering LTCF, which is based on a CXR. The results indicate that a targeted search for active TB in people with symptoms or other high-risk medical conditions may be more cost-effective.

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Section: Assessment Of Cxr and Other Methods To Screen For Tb In Ltcfmentioning

confidence: 92%

Section: Cost-effectiveness Of Screening Using Cxr To Find Active Tb Casesmentioning

confidence: 99%

Review of Evidence for Using Chest X-Rays for Active Tuberculosis Screening in Long-Term Care in Canada

Herrera

Haworth‐Brockman

Keynan

2020

Front. Public Health

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“…Four previous cost-effectiveness studies of TB have been reported to compare screening strategies with no screening in the elderly [ 31 – 33 , 72 ]. Two of them demonstrated that TST screening was more cost-effective than no screening and CXR screening in long-term care facilities for the elderly in Canada [ 31 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…The other two studies in Japan BCG-vaccinated elderly and nursing homes demonstrated that QFT-GIT screening was the most cost-effective among screening strategies by TST, CXR and other products of IGRAs [ 32 , 72 ]. The sensitivity of IGRA, prevalence of LTBI and TB, and BCG rate in TST screening were the influential variables [ 32 , 72 ]. The uncertainty of these variables were not significantly observed in our study because of the higher prevalence rates in Hong Kong RCHEs and the exclusion of TST.…”

Section: Discussionmentioning

confidence: 99%

Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area

Yip

Leung

et al. 2018

PLoS ONE

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BackgroundTuberculosis (TB) in the elderly remains a challenge in intermediate disease burden areas like Hong Kong. Given a higher TB burden in the elderly and limited impact of current case-finding strategy by patient-initiated pathway, proactive screening approaches for the high-risk group could be optimal and increasingly need targeted economic evaluations. In this study, we examined whether and under what circumstance the screening strategies are cost-effective compared with no screening strategy for the elderly at admission to residential care homes.MethodsA decision analytic process based on Markov model was adopted to evaluate the cost-effectiveness of four strategies: (i) no screening, (ii) TB screening (CXR) and (iii) TB screening (Xpert) represent screening for TB in symptomatic elderly by chest X-ray and Xpert® MTB/RIF respectively, and (iv) LTBI/TB screening represents screening for latent and active TB infection by QuantiFERON®-TB Gold In-Tube and chest X-ray. The target population was a hypothetical cohort of 65-year-old people, using a health service provider perspective and a time horizon of 20 years. The outcomes were direct medical costs, life-years and quality-adjusted life-years (QALYs) measured by incremental cost-effectiveness ratio (ICER).ResultsIn the base-case analysis, no screening was the most cost-saving; TB screening (CXR) was dominated by TB screening (Xpert); LTBI/TB screening resulted in more life-years and QALYs accrued. The ICERs of LTBI/TB screening were US$19,712 and US$29,951 per QALY gained compared with no screening and TB screening (Xpert), respectively. At the willingness-to-pay threshold of US$50,000 per QALY gained, LTBI/TB screening was the most cost-effective when the probability of annual LTBI reactivation was greater than 0.155% and acceptability of LTBI/TB screening was greater than 38%. In 1,000 iterations of Monte Carlo simulation, the probabilities of no screening, TB screening (CXR), TB screening (Xpert), and LTBI/TB screening to be cost-effective were 0, 1.3%, 20.1%, and 78.6% respectively.ConclusionsScreening for latent and active TB infection in Hong Kong elderly people at admission to residential care homes appears to be highly effective and cost-effective. The key findings may be the next key factor to bring down TB endemic in the elderly population among intermediate TB burden areas.

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“…LTBI testing guidelines may be difficult to follow in practice, and simplification of these might improve testing rates. Recent data suggest that IGRA testing may be most cost‐effective for this population . The high prevalence of LTBI in these LTCFs underscores the need to address whether to treat such individuals—for their own health as well as the benefit of other LTCF residents.…”

Section: Discussionmentioning

confidence: 99%

Latent Tuberculosis Infection Testing Practices in Long‐Term Care Facilities, Boston, Massachusetts

Reddy

Walker

White

et al. 2017

J American Geriatrics Society

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Cost-effectiveness of interferon-gamma release assays for tuberculosis screening in nursing homes

Cited by 7 publications

References 28 publications

Review of Evidence for Using Chest X-Rays for Active Tuberculosis Screening in Long-Term Care in Canada

Review of Evidence for Using Chest X-Rays for Active Tuberculosis Screening in Long-Term Care in Canada

Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area

Latent Tuberculosis Infection Testing Practices in Long‐Term Care Facilities, Boston, Massachusetts

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