Tuberculin skin test and interferon-gamma release assay use among privately insured persons in the United States

Owusu-Edusei, Kwame; Stockbridge, Erica L.; Winston, Carla A.; Kolasa, Maureen; Miramontes, Roque

doi:10.5588/ijtld.16.0617

Cited by 4 publications

(9 citation statements)

References 15 publications

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“…The primary explanatory variable was a categorical variable that detailed the pattern of LTBI testing received within the 6 months prior to isoniazid treatment initiation. Specifically, TST and IGRA testing was identified based on CPT codes, with code 86580 identifying TSTs and codes 86480 and 86481 identifying IGRAs [14]. No otherwise eligible persons had data containing CPT codes 0010T or 86585 so they were not considered in our analysis.…”

Section: Methodsmentioning

confidence: 99%

“…In accordance with the algorithm logic, we required that the data be available to determine if LTBI treatment was completed. We also required that a Current Procedural Terminology (CPT) code for a TST or IGRA [14] be present on a claim within the 6 months prior to treatment initiation, and we required that data describing the individuals' counties of residence be available.…”

Section: Data Sourcementioning

confidence: 99%

“…Diagnostic confidence may influence completion rates, and it is plausible that there are important differences in treatment completion following diagnosis via interferon gamma release assays (IGRA) versus tuberculin skin tests (TST). Although TSTs have been in widespread use for over a century [14] they may yield false-positive test results in persons who have had bacille Calmette-Guerin (BCG) vaccines [15,16]. There is widespread use of BCG vaccination in countries other than the US [17] and LTBI prevalence is highest in non-US-born persons [18,19], so it is plausible that confidence in TST as a diagnostic presents a barrier in such key high-risk populations [8,20,21].…”

Section: Introductionmentioning

confidence: 99%

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Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States: Evidence from commercial insurance data

et al. 2020

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Background Risk-targeted testing and treatment of latent tuberculosis infection (LTBI) is a critical component of the United States’ (US) tuberculosis (TB) elimination strategy, but relatively low treatment completion rates remain a challenge. Both treatment persistence and completion may be facilitated by diagnosing LTBI using interferon gamma release assays (IGRA) rather than tuberculin skin tests (TST). Methods We used a national sample of administrative claims data to explore associations diagnostic test choice (TST, IGRA, TST with subsequent IGRA) and treatment persistence and completion in persons initiating a daily dose isoniazid LTBI treatment regimen in the US private healthcare sector between July 2011 and March 2014. Associations were analyzed with a generalized ordered logit model (completion) and a negative binomial regression model (persistence). Results Of 662 persons initiating treatment, 327 (49.4%) completed at least the 6-month regimen and 173 (26.1%) completed the 9-month regimen; 129 (19.5%) persisted in treatment one month or less. Six-month completion was least likely in persons receiving a TST (42.2%) relative to persons receiving an IGRA (55.0%) or TST then IGRA (67.2%; p = 0.001). Those receiving an IGRA or a TST followed by an IGRA had higher odds of completion compared to those receiving a TST (aOR = 1.59 and 2.50; p = 0.017 and 0.001, respectively). Receiving an IGRA or a TST and subsequent IGRA was associated with increased treatment persistence relative to TST (aIRR = 1.14 and 1.25; p = 0.027 and 0.009, respectively). Conclusions IGRA use is significantly associated with both higher levels of LTBI treatment completion and treatment persistence. These differences are apparent both when IGRAs alone were administered and when IGRAs were administered subsequent to a TST. Our results suggest that IGRAs contribute to more effective LTBI treatment and consequently individual and population protections against TB.

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Section: Methodsmentioning

confidence: 99%

Section: Data Sourcementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States: Evidence from commercial insurance data

et al. 2020

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“…The information on the unique TB test usage and medical expenditures provides the benchmarks necessary for monitoring private sector testing practices and medical expenditures over time, especially with increased access to private health insurance through the Affordable Health Care Act beginning in 2014. After examining trends in the use of IGRAs and TST among privately insured persons in the United States over a 15-year period (2000–2014), a recent study suggested a gradual shift from the use of TST to IGRAs [ 26 ]. Future studies can examine the trends in the individual test payments, including the associated shift, if any, in the total expenditures from TST to IGRAs over time.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis Test Usage and Medical Expenditures from Outpatient Insurance Claims Data, 2013

Owusu-Edusei

Winston

Marks

et al. 2017

Tuberculosis Research and Treatment

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Objective To evaluate TB test usage and associated direct medical expenditures from 2013 private insurance claims data in the United States (US). Methods We extracted outpatient claims for TB-specific and nonspecific tests from the 2013 MarketScan® commercial database. We estimated average expenditures (adjusted for claim and patient characteristics) using semilog regression analyses and compared them to the Centers for Medicare and Medicaid Services (CMS) national reimbursement limits. Results Among the TB-specific tests, 1.4% of the enrollees had at least one claim, of which the tuberculin skin test was most common (86%) and least expensive ($9). The T-SPOT® was the most expensive among the TB-specific tests ($106). Among nonspecific TB tests, the chest radiograph was the most used test (78%), while chest computerized tomography was the most expensive ($251). Adjusted average expenditures for the majority of tests (≈74%) were above CMS limits. We estimated that total United States medical expenditures for the employer-based privately insured population for TB-specific tests were $53.0 million in 2013, of which enrollees paid 17% ($9 million). Conclusions We found substantial differences in TB test usage and expenditures. Additionally, employer-based private insurers and enrollees paid more than CMS limits for most TB tests.

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“…Thus, LTBI testing should be targeted toward individuals and populations with known risks [ 25 ]. While it is known that some testing already occurs in the US private sector [ 26 ], it is unknown whether such testing is well-targeted. Understanding the appropriateness of LTBI testing occurring within this increasingly important setting is necessary in order for public health leaders to shape the delivery of these services in the future.…”

Section: Introductionmentioning

confidence: 99%

Private sector tuberculosis prevention in the US: Characteristics associated with interferon-gamma release assay or tuberculin skin testing

et al. 2018

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ObjectiveTo determine whether latent tuberculosis infection risk factors are associated with an increased likelihood of latent tuberculosis infection testing in the US private healthcare sector.Data sourceA national sample of medical and pharmacy claims representing services rendered January 2011 through December 2013 for 3,997,986 commercially insured individuals in the US who were 0 to 64 years of age.Study designWe used multivariable logistic regression models to determine whether TB/LTBI risk factors were associated with an increased likelihood of Interferon-Gamma Release Assay (IGRA) or Tuberculin Skin Test (TST) testing in the private sector.Principal findings4.31% (4.27–4.34%) received at least one TST/IGRA test between 2011 and 2013 while 1.69% (1.67–1.72%) received a TST/IGRA test in 2013. Clinical risk factors associated with a significantly increased likelihood of testing included HIV, immunosuppressive therapy, exposure to tuberculosis, a history of tuberculosis, diabetes, tobacco use, end stage renal disease, and alcohol use disorder. Other significant variables included gender, age, asthma, the state tuberculosis rate, population density, and percent of foreign-born persons in a county.ConclusionsPrivate sector TST/IGRA testing is not uncommon and testing varies with clinical risk indicators. Thus, the private sector can be a powerful resource in the fight against tuberculosis. Analyses of administrative data can inform how best to leverage private sector healthcare toward tuberculosis prevention activities.

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Tuberculin skin test and interferon-gamma release assay use among privately insured persons in the United States

Abstract: These results suggest a gradual shift from the use of the TST to the newer IGRAs. Future studies can assess the extent, if any, to which the shift from the use of the TST to IGRAs evolved over time.

Cited by 4 publications

References 15 publications

Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States: Evidence from commercial insurance data

Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States: Evidence from commercial insurance data

Tuberculosis Test Usage and Medical Expenditures from Outpatient Insurance Claims Data, 2013

Private sector tuberculosis prevention in the US: Characteristics associated with interferon-gamma release assay or tuberculin skin testing

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