Direct costs of three models for the screening of latent tuberculosis infection

Wrighton-Smith, P.; Jp, Zellweger

doi:10.1183/09031936.06.00005906

Cited by 75 publications

(35 citation statements)

References 31 publications

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“…However, the fact that most of the costs for TB control are incurred during diagnosis and treatment of patients with active TB suggests that higher diagnostic sensitivity and higher specificity could induce cost savings in the medium and long term by reducing the future burden of cases of active TB and decreasing the number of uninfected BCG-vaccinated people inappropriately treated for LTBI (18). Studies in Switzerland and Germany have shown that the most cost-effective method for LTBI screening is the two-step strategy (TST followed by IGRA in TST-positive patients) (53,54). The cost-effectiveness of this strategy is probably related to low prevalence of LTBI and high prevalence of BCG history in these countries.…”

Section: The Ifn-␥ Release Assays: Advantages Over the Tstmentioning

confidence: 99%

Diagnosis of Tuberculosis in Dialysis Patients

Segall

Covic²

2010

Clinical Journal of the American Society of Nephrology

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Patients with ESRD undergoing chronic dialysis are much more prone to develop tuberculosis (TB) than the general population. In these patients, the diagnosis of TB disease is often difficult because of prevailing extrapulmonary involvement and nonspecific symptoms. The prevalence of latent TB infection (LTBI) in ESRD patients is elevated, and those who become infected are at high risk of developing active disease. Therefore, screening for LTBI in this population is recommended, aiming to prevent progression to active TB and secondary contamination of others. The tuberculin skin test (TST), the classic diagnostic tool for LTBI, has several major drawbacks, including poor sensitivity (because of a high prevalence of anergy in dialysis patients) and specificity [with false-positive tests in those vaccinated with bacille Calmette-Guérin (BCG)]. In the past 10 years or so, new immunological tests using IFN-␥ release assays (IGRAs) have become available and have shown superior sensitivity and specificity for the diagnosis of TB compared with the TST in several studies, some very recent ones including ESRD patients. Therefore, current strategy in dialysis patients should use these tests instead of TST for LTBI screening and as an aid for the diagnosis of active TB.

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Section: The Ifn-␥ Release Assays: Advantages Over the Tstmentioning

confidence: 99%

Diagnosis of Tuberculosis in Dialysis Patients

Segall

Covic²

2010

Clinical Journal of the American Society of Nephrology

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“…The costs of LTBI testing and treatment were recently published in a cost minimisation study from the Swiss healthcare perspective [9]. Asymptomatic infection is assumed to produce no cost (except the cost of testing, which would have been incurred irrespective of infection).…”

Section: Costs Of Ltbi Screening and Treatmentmentioning

confidence: 99%

“…The costs of testing comprised the labour cost for the staff performing the TST or drawing blood, as well as the material cost of the vial and associated consumables for each TST at CHF 35 (J23). As reimbursement has not yet been formalised for the T-SPOT.TB test in Switzerland, an estimate for the total cost of the screening kit, reagents and laboratory fees was taken as CHF 200 (J129) for each T-SPOT.TB test as previously described [9].…”

Section: Costs Of Ltbi Screening and Treatmentmentioning

confidence: 99%

“…In two papers [8,9] the way in which IGRA can be used for cost-saving in initial screening has been discussed. However, the long-term economic consequences and healthcare outcomes of this new approach for detecting Mycobacterium tuberculosis infection were not examined in the context of subsequent treatment of LTBI in comparison with existing programmes based upon the TST.…”

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confidence: 99%

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Cost-effectiveness of interferon-γ release assay testing for the treatment of latent tuberculosis

Diel

Wrighton-Smith²,

Jp³

2007

Eur Respir J

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The aim of the present study was to assess the cost-effectiveness of the new T-SPOT.TB assay versus the tuberculin skin test (TST) for screening contacts for latent tuberculosis (TB) infection in Switzerland.Health and economic outcomes of isoniazid treatment of 20-and 40-yr-old close contacts were compared in a Markov model over a 20-yr period following screening with TST only (at three cutoff values) and T-SPOT.TB alone or in combination with the TST.T-SPOT.TB-based treatment was cost-effective at J11,621 and J23,692 per life-year-gained (LYG) in the younger and older age group, respectively. No TST-based programmes were costeffective, except at a 15-mm cut-off in the younger group only, where the cost-effectiveness (J26,451?LYG -1 ) fell just below the willingness-to-pay threshold. Combination of the TST with T-SPOT.TB slightly reduced the total cost compared with the T-SPOT.TB alone by 4.4 and 5.0% in the younger and older groups respectively. The number of contacts treated to avoid one case of TB decreased from 50 (95% confidence interval 32-106) with the TST (10-mm cut-off) to 18 (95%CI 11-43) if T-SPOT.TB was used. Using T-SPOT.TB alone or in combination with the tuberculin skin test for screening of close contacts before latent tuberculosis infection treatment is highly cost-effective in reducing the disease burden of tuberculosis.KEYWORDS: Cost-effectiveness, interferon-c release assay, latent tuberculosis infection, latent tuberculosis infection treatment, tuberculosis S creening the contacts of patients with tuberculosis (TB) is recommended as a strategy to detect infected persons who may develop the disease at a later time. It has been demonstrated that preventive treatment, mainly with isoniazid, decreases the number of future cases of TB. This strategy is therefore recommended in countries with a low incidence rate of TB, in order to further decrease the burden of disease [1]. The effectiveness and cost-effectiveness of these programmes are strongly affected by the accuracy of identifying truly infected individuals who have a risk of developing future disease. Owing to the limited sensitivity and specificity of the tuberculin skin test (TST), it follows that the current cost-effectiveness of screening may be improved if more accurate tools are used for screening for latent tuberculosis infection (LTBI).Numerous studies screening recent contacts of infectious TB patients for LTBI using the new highly specific interferon-c release assays (IGRA) have recently been published [2][3][4][5][6][7], but no study has produced cost-effectiveness data. In two papers [8,9] the way in which IGRA can be used for cost-saving in initial screening has been discussed. However, the long-term economic consequences and healthcare outcomes of this new approach for detecting Mycobacterium tuberculosis infection were not examined in the context of subsequent treatment of LTBI in comparison with existing programmes based upon the TST.As intervention options in all therapeutic areas grow, government and third-party...

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“…[165,166] Wrighton-Smith found similar results, suggesting that sequential testing of TST followed by IGRA may be a more cost-effective strategy. [167] On the other hand, Oxlade found that IGRA was the least cost-effective strategy for testing of immigrants. [157] Little research has been done looking at the effect of IGRA on the cost-effectiveness of targeted testing programs in other heterogeneous, low-prevalence populations.…”

Section: Cost-effectiveness Of Screening Policiesmentioning

confidence: 99%

An Evaluation of the Latent Tuberculosis Control Program in the United States Military at Accession

Mancuso¹

2010

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Direct costs of three models for the screening of latent tuberculosis infection

Cited by 75 publications

References 31 publications

Diagnosis of Tuberculosis in Dialysis Patients

Diagnosis of Tuberculosis in Dialysis Patients

Cost-effectiveness of interferon-γ release assay testing for the treatment of latent tuberculosis

An Evaluation of the Latent Tuberculosis Control Program in the United States Military at Accession

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