Decreasing cost effectiveness of testing for latent TB in HIV in a low TB incidence area

Abstract

Testing for latent tuberculosis infection (LTBI) in HIV-infected persons in low tuberculosis (TB) incidence areas is often recommended. Using contemporary, clinical data, we report the yield and cost-effectiveness of testing all HIV attendees, two current UK strategies and no LTBI testing.Economic modelling was performed utilising 10-year follow up data from a large HIV clinical cohort. Outcomes were numbers of cases of active TB and incremental cost per quality-adjusted life year (QALY) gained.Between 2000 and 2010, 256 people were treated for TB/HIV co-infection. 72 (28%) occurred ⩾3 months after HIV diagnosis and may have been prevented by LTBI testing. Between 2000 and 2005, the incremental cost per QALY gained for the British HIV Association (BHIVA) and UK National Institute of Care Excellence (NICE) strategies, and testing all clinic attendees was €6270, €6998 and €33 473, respectively. These rose to €9332, €32 564 and €74 067, respectively, between 2005 and 2010. Probabilistic sensitivity analysis suggested that at a threshold of €24 000 per additional QALY, the most cost-effective strategies would be NICE or testing all in 2000 -2005 and BHIVA during 2005 Both UK testing regimens missed cases but are cost-effective compared with no testing. Using recent data, they all became more expensive, suggesting that alternative or more targeted TB testing strategies must be considered. @ERSpublications Targeted latent TB testing strategies in HIV are cost effective, but lately have become more expensive

The cost‐effectiveness of treating triple coinfection with HIV, tuberculosis and hepatitis C virus

“…There is not much literature on screening for and treatment of TB, but we have two good examples with discordant results: in a study that investigated the costeffectiveness of screening for and treatment of TB using an analytical model, Steffen et al obtained values that varied from $101 948 to $227 977 per case averted [12]. Capocci et al [13] developed an economic model utilizing 10-year follow-up data from a large clinical HIV-infected cohort, suggesting that at a threshold of €24 000 per additional QALY, screening for TB is costeffective.…”

“…Capocci et al . developed an economic model utilizing 10‐year follow‐up data from a large clinical HIV‐infected cohort, suggesting that at a threshold of €24 000 per additional QALY, screening for TB is cost‐effective.…”

The cursed duet today: Tuberculosis and HIV-coinfection

“…Cavitary pulmonary cases are more likely to be smear positive, whereas a negative smear in a patient with minimal findings on chest radiograph is not unusual, and does not rule out active TB. Testing for TB infection in those with a known HIV diagnosis is cost-effective even in low-incidence settings [33].…”

HIV and respiratory illness in the antiretroviral therapy era

“…Also, the changing demographics of TB in many, generally resource rich locations mean that current guideline recommendations soon may not be cost-effective. (57) There is a need to improve the evidence base supporting preventative strategies for TB for PLWH. Improved diagnostic tests with a better ability to predict who is at risk of developing TB than the currently available immune-based tuberculin skin tests and TB interferon gamma release assays would significantly improve the benefit and cost-effectiveness of such testing.…”