Predictive performance of interferon-gamma release assays and the tuberculin skin test for incident tuberculosis: an individual participant data meta-analysis

Hamada, Yohhei; Gupta, Rishi; Quartagno, Matteo; Izzard, Abbie; Acuña-Villaorduña, Carlos; Altet, Neus; Diel, Roland; Domínguez, José; Floyd, Sian; Gupta, Amita; Huerga, Helena; Jones-López, Edward C.; Kinikar, Aarti; Lange, Christoph; Leth, Frank van; Li, Qiao; Lü, Wei; Lü, Peng; Rueda, Irene Latorre; Martínez, Leonardo; Mbandi, Stanley Kimbung; Muñoz, Laura; Padilla, Elisabeth Sánchez; Paradkar, Mandar; Scriba, Thomas J.; Sester, Martina; Shanaube, Kwame; Sharma, Surendra Kumar; Sloot, Rosa; Sotgiu, Giovanni; Thiruvengadam, Kannan; Vashishtha, Richa; Abubakar, Ibrahim; Rangaka, Molebogeng X

doi:10.1016/j.eclinm.2022.101815

Cited by 20 publications

(14 citation statements)

References 53 publications

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“…skin tests). Most IGRA estimates this analysis were based on QFT, however results would unlikely differ for T-SPOT since the IGRA types perform similarly [ 5 , 8 ]. Lastly, while we used the best available data on the test accuracy from a recent systematic review, there were limited data on Diaskintest.…”

Section: Discussionmentioning

confidence: 99%

“…All parameters are sourced from the literature including tests’ specificity and sensitivity. TBST specificity is currently assumed to be equal to that of the IGRA (QuantiFERON-TB or T-SPOT.TB [ 8 ]). We used a population-based approach integrating all individuals having a recent TBI, including TB case contacts, immunocompromised populations, among other vulnerable groups.…”

Section: Methodsmentioning

confidence: 99%

“…All parameters are sourced from the literature including tests' specificity and sensitivity. TBST specificity is currently assumed to be equal to that of the IGRA (QuantiFERON-TB or T-SPOT.TB [8]).…”

Section: Model Parametersmentioning

confidence: 99%

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Economic evaluation of novel Mycobacterium tuberculosis specific antigen-based skin tests for detection of TB infection: A modelling study

Goscé,

Allel,

Hamada

et al. 2023

PLOS Glob Public Health

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Evidence on the economic impact of novel skin tests for tuberculosis infection (TBST) is scarce and limited by study quality. We used estimates on the cost-effectiveness of the use of TBST compared to current tuberculosis infection (TBI) tests to assess whether TBST are affordable and feasible to implement under different country contexts. A Markov model parametrised to Brazil, South Africa and the UK was developed to compare the cost-effectiveness of three TBI testing strategies: (1) Diaskintest (DST), (2) TST test, and (3) IGRA QFT test. Univariate and probabilistic sensitivity analyses over unit costs and main parameters were performed. Our modelling results show that Diaskintest saves $5.60 and gains 0.024 QALYs per patient and $8.40, and 0.01 QALYs per patient in Brazil, compared to TST and IGRA respectively. In South Africa, Diaskintest is also cost-saving at $4.39, with 0.015 QALYs per patient gained, compared to TST, and $64.41, and 0.007 QALYs per patient, compared to IGRA. In the UK, Diaskintest saves $73.33, and gaines 0.0351 QALYs per patient, compared to TST. However, Diaskintest, compared to IGRA, showed an incremental cost of $521.45 (95% CI (500.94–545.07)) per QALY, below the willingness-to-pay threshold of $20.223 per QALY. Diaskintest potentially saves costs and results in greater health gains than the TST and IGRA tests in Brazil and South Africa. In the UK Diaskintest would gain health but also be more costly. Our results have potential external validity because TBST remained cost-effective despite extensive sensitivity analyses.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Economic evaluation of novel Mycobacterium tuberculosis specific antigen-based skin tests for detection of TB infection: A modelling study

Goscé,

Allel,

Hamada

et al. 2023

PLOS Glob Public Health

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“…Eine aktive Tuberkulose sollte so weit wie möglich ausgeschlossen sein. Für erwachsene Personen in Niedrig-Inzidenzländern wie Deutschland und ohne bekannten Immundefekt ist der IGRA dem THT bei der Risikobewertung überlegen [11]. Die Entscheidung für eine präventive Therapie der Tuberkulose bei Kontaktpersonen mit einer MDR/RR-TB hängt von der Wahrscheinlichkeit der Ansteckung und dem Resistenzprofil der Bakterien des Indexpatienten ab.…”

Section: Prävention Der Mdr/rr-tbunclassified

Management der antibiotikaresistenten Tuberkulose

Lange

2023

Dtsch Med Wochenschr

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“…However, TST require healthcare consumers to attend two clinic appointments 72 hours apart to have the test administered and the result read, which can pose a challenge in remote communities (4). Moreover, TST have lower sensitivity and speci city relative to IGRA, with differences varying by setting and population (5)(6)(7). IGRA involve a blood sample, thus they require a greater degree of resources to administer including a phlebotomist and a laboratory for sample storage and analysis.…”

Section: Introductionmentioning

confidence: 99%

End-user perspectives on the acceptability, feasibility, and health equity impacts of Mycobacterium tuberculosis specific antigen-based skin tests compared to interferon gamma release assays and the tuberculin skin test: A semi-structured interview study

Loveys,

Chan,

Hamada

et al. 2024

Preprint

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Background Antigen-based skin tests (TBST) have been developed for detecting Mycobacterium tuberculosis (TB) infection (TBI). TBST may have comparable sensitivity and specificity to Interferon Gamma Release Assays (IGRA), the gold standard in TBI testing. However, they are portable and low cost, and may be better suited for use in large scale screening programmes and in resource-limited settings. To date, there is limited evidence on stakeholder values and preferences, and the acceptability, feasibility, and health equity impacts of TBST relative to existing TBI tests. Methods We explored end-user values and preferences, and perspectives on the acceptability, feasibility, and health equity impacts of TBST compared to IGRA and tuberculin skin tests (TST). 20 semi-structured interviews were conducted with TB healthcare consumers and providers from low-middle and high-income countries between Sept 07, 2021 and Nov 01, 2021. Data were transcribed verbatim and coded by two independent raters using inductive thematic analysis. Results Seven consumers and 13 providers of TB healthcare were interviewed from 11 low-middle and 9 high-income countries. Healthcare consumers and providers shared similar values and preferences towards TBI tests. Stakeholders valued TBI test accuracy, convenience, cost, patient experience, and resource requirements. Overall, TBST were viewed as more acceptable and equally feasible to TST, with greater health equity benefits from improved sensitivity and specificity. TBST were generally viewed to be less acceptable than IGRA due to some undesirable aspects of the patient experience (eg requires two patient visits, stigma and discomfort from the arm welt). TBST were viewed as more feasible than IGRA in resource-limited settings due to their portability and low cost. However, TBST are unlikely to replace IGRA in high-resource settings where the resourcing is already in place to support IGRA use. Conclusions TBST may be a more accurate alternative to TST that could be used in large scale screening programmes and in resource-limited healthcare settings. IGRA are likely to remain the preferred TBI test in high-resource healthcare settings as they have comparable sensitivity and specificity, and the resourcing is already in place for IGRA use. These findings may inform decision-making on TBI tests in global public healthcare.

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Predictive performance of interferon-gamma release assays and the tuberculin skin test for incident tuberculosis: an individual participant data meta-analysis

Cited by 20 publications

References 53 publications

Economic evaluation of novel Mycobacterium tuberculosis specific antigen-based skin tests for detection of TB infection: A modelling study

Economic evaluation of novel Mycobacterium tuberculosis specific antigen-based skin tests for detection of TB infection: A modelling study

Management der antibiotikaresistenten Tuberkulose

End-user perspectives on the acceptability, feasibility, and health equity impacts of Mycobacterium tuberculosis specific antigen-based skin tests compared to interferon gamma release assays and the tuberculin skin test: A semi-structured interview study

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