Tuberculosis screening for long-term care: a cost-effectiveness analysis

Verma, Geetika; Chuck, Anderson; Jacobs, Philip

doi:10.5588/ijtld.12.0934

Cited by 13 publications

(32 citation statements)

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“…The latter is also called active case-finding (ACF). Screening for LTBI relies on the measurement of cellular responses to TB antigens, either by tuberculin skin test (TST) [6, 13, 19–28, 30, 32] or Interferon-Gamma Release Assay (IGRA) [6, 26–28, 31]. For ACF, chest X-ray (CXR) is mainly adopted such as in contact investigation or in combination with annual health screening program.…”

Section: Resultsmentioning

confidence: 99%

“…In the elderly, owing to few opportunity in receiving Bacillus Calmette-Guerin (BCG) vaccination in their childhood and various immunologic response, multiple cut-offs are therefore recommended to give the best predictive values under different clinical and epidemiologic situations [6, 13, 19]. Factors such as separate test-reading visit, potential boosting of response on serial testing ascribed to immune-compromised, as well as cross-reactivity with the BCG and nontuberculous mycobacteria (NTM), affect its field application with decreased sensitivity and specificity in the elderly [6, 13, 19–28, 30, 31]. IGRAs are new alternatives to TST with at least equivalent sensitivity and higher specificity [6, 31].…”

Section: Resultsmentioning

confidence: 99%

“…Based on three studies in particular long-term care facility and BCG-vaccinated elderly, no screening strategy offered the greatest cost savings [31]; screening with TST was more cost-effective than CXR screening or passive strategy [30, 32]; IGRAs may become more cost-effective when its sensitivity was over 0.89 and TB prevalence was higher [31]; CXR screening was less cost-effective than no screening for BCG-vaccinated elderly [31]. It was also noted that for newly admitted elderly in long-term care facilities, although the health benefits of screening were significant [13, 19, 32], strategies might not be cost-effective in a low-burden setting [30]. Identifying the elderly with highest reactivation risk would improve the cost-effectiveness of screening [30].…”

Section: Resultsmentioning

confidence: 99%

“…It was also noted that for newly admitted elderly in long-term care facilities, although the health benefits of screening were significant [13, 19, 32], strategies might not be cost-effective in a low-burden setting [30]. Identifying the elderly with highest reactivation risk would improve the cost-effectiveness of screening [30]. Economic evaluation was also considered in national TB control strategies.…”

Section: Resultsmentioning

confidence: 99%

“…Preventive treatment in the elderly is recognized as the most effective single intervention which can directly reduce the size of the latent reservoir [15]. Isoniazid preventive therapy (IPT) is the preferred therapy [6, 13, 15, 19–28, 30, 31], with the regime ranged from 6 months to 9 month, and 12 months advised for HIV-infected patients [6, 13, 19, 20, 22, 25]. Other studies indicated 9 months was preferred to the 6 or 12 months regimen regardless of HIV status [15, 26, 28].…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Chung

Leung

et al. 2017

Infect Dis Poverty

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With the rapid pace of population ageing, tuberculosis (TB) in the elderly increasingly becomes a public health challenge. Despite the increasing burden and high risks for TB in the elderly, targeted strategy has not been well understood and evaluated. We undertook a scoping review to identify current TB strategies, research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets. Databases of Embase, MEDLINE, Global health and EBM reviews were searched for original studies, review articles, and policy papers published in English between January 1990 and December 2015. Articles examining TB strategy, program, guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria. Most of them were qualitative studies, issued in high- and middle-income countries and after 2000. To break the chain of TB transmission and reactivation in the elderly, infection control, interventions of avoiding delay in diagnosis and containment are essential for preventing transmission, especially in elderly institutions and aged immigrants; screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people; optimizing early case-finding with a high index of suspicion, systematic screening for prioritized high-risk groups, initial empirical and adequate follow-up treatment with close monitoring and evaluation, as well as enhanced programmatic management are fundamental pillars for active TB elimination. Evaluation of TB epidemiology, risk factors, impacts and cost-effectiveness of interventions, adopting accurate and rapid diagnostic tools, shorter and less toxic preventive therapy, are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway. The framework and principals identified in this study will help to evaluate and improve current program, develop targeted strategy, as well as raise more discussions on the research priority settings and policy transitions. Given the scarceness of policy and evaluated interventions, as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries, the increasing need of a ready TB program for the elderly warrants further research.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0284-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Chung

Leung

et al. 2017

Infect Dis Poverty

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Battling Tuberculosis beyond antibiotics

Petrou

2017

Value in Health Regional Issues

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

Kowada¹

2016

Epidemiol. Infect.

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Tuberculosis (TB) in older people is a significant public health problem in low TB-incidence countries. Older persons have increased TB incidence, higher reactivation and mortality. A delay in diagnosis and initiation of TB treatment in patients with atypical clinical and radiological features is a significant factor of widespread transmission. This study aimed to evaluate the cost-effectiveness of interferon-gamma release assays [IGRAs; QuantiFERON®-TB Gold In-Tube (QFT) and T-SPOT®.TB (T-SPOT)] compared to the tuberculin skin test (TST) and chest X-ray (CXR) examination for TB screening for nursing homes. Decision trees and Markov models were constructed using a societal perspective on a lifetime horizon. Seven strategies: no screening, TST, QFT, T-SPOT, TST followed by QFT, TST followed by T-SPOT, and CXR were considered. QFT [US$ 401·9, 4·36 707 QALY (year 2014 values)] was the most cost-effective at the willingness-to-pay level of US$ 50 000/QALY gained. TST followed by QFT was the most cost-effective in residents with comorbidities. CXR was less cost-effective. Cost-effectiveness was sensitive to latent TB infection (LTBI) rate and bacillus Calmette-Guérin vaccination rate. Effective LTBI screening using IGRA is recommended to prevent TB transmission not only in nursing homes but also in local communities in low-incidence countries.

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Tuberculosis screening for long-term care: a cost-effectiveness analysis

Cited by 13 publications

References 0 publications

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Battling Tuberculosis beyond antibiotics

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

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