Interferon-gamma release assay for tuberculosis screening of solid-organ transplant recipients is cost-effective.

OBJECTIVES: Tuberculosis (TB) is a serious infectious disease with high mortality for solid-organ transplantation. Preventive therapy of latent tuberculosis infection (LTBI) has been considered to reduce TB risk and improve outcomes of transplantation. The aim of this study was to evaluate the cost-effectiveness of the interferon-gamma release assays (IGRAs); QuantiFERON®-TB Gold in-Tube (QFT) and T-SPOT®.TB (TSPOT)), for kidney, liver and lung transplant recipients in low TB incidence countries. METHODS: Decision trees and Markov models were developed for four strategies; QFT, TSPOT, the tuberculin skin test (TST) and no screening. Targeted populations were hypothetical cohorts of kidney, liver and lung transplant recipients aged 40 years using a societal perspective on a lifetime horizon. Per-person costs, effectiveness and incremental cost effectiveness ratios were calculated and compared. RESULTS: QFT was the most cost-effective (Kidney; US$ 5679, 3.026 QALYs, Liver; US$ 5914, 2.365 QALYs, Lung; US$ 6092, 3.761 QALYs). No screening was the least effective. Cost-effectiveness was not sensitive to BCG vaccination rate, and the costs of screening tests and treatment. CONCLUSIONS: TB screening using IGRA with individualized TB risk assessment and follow-up monitoring of drug toxicity during LTBI treatment is recommended for solid organ transplantation, on the basis of the benefits and cost-effectiveness.

Cost-effectiveness of Helicobacter pylori screening followed by eradication treatment for employees in Japan.

Gastric cancer is the third leading cause of cancer death worldwide. Gastric cancer screening using upper gastrointestinal series, endoscopy and serological testing has been performed in population-based (employee-based and community-based) and opportunistic cancer screening in Japan. There were 45 531 gastric cancer deaths in 2016, with the low screening and detection rates. Helicobacter pylori (H. pylori) screening followed by eradication treatment is recommended in high-risk population settings to reduce gastric cancer incidence. The aim of this study was to evaluate the cost-effectiveness of H. pylori screening followed by eradication treatment for a high-risk population in the occupational health setting. Decision trees and Markov models were developed for two strategies; H. pylori antibody test (HPA) screening and no screening. Targeted populations were hypothetical cohorts of employees aged 20, 30, 40, 50 and 60 years using a company health payer perspective on a lifetime horizon. Per-person costs and effectiveness (quality-adjusted life-years) were calculated and compared. HPA screening yielded greater benefits at the lower cost than no screening. One-way and probabilistic sensitivity analyses using Monte-Carlo simulation showed strong robustness of the results. H. pylori screening followed by eradication treatment is recommended to prevent gastric cancer for employees in Japan, on the basis of cost-effectiveness.

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

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.

Cost-effectiveness of tobacco cessation support combined with tuberculosis screening among contacts who smoke.

SETTING: Tobacco smoking is associated with significantly increased risks of latent tuberculous infection, active tuberculosis (TB), TB recurrence and mortality. Tobacco cessation interventions not only increase health benefits, they also reduce the risk of TB. OBJECTIVE: To assess the cost-effectiveness of nicotine replacement therapy (NRT) combined with TB screening strategies using interferon-gamma release assays (IGRAs; QuantiFERON(®)-TB Gold In-Tube [QFT] and T-SPOT(®).TB [T-SPOT]) and comparing these with the tuberculin skin test (TST) among TB contacts who smoke. DESIGN: Decision trees and Markov models were constructed from a public health perspective. The target population was a hypothetical cohort of 20-year-old contacts who smoke until the age of 70 years, with or without NRT. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio was compared. RESULTS: QFT alone led to lower costs but fewer QALYs. TST alone and TST+NRT were absolutely dominated. IGRAs+NRT yielded greater benefits than IGRAs alone, and T-SPOT+NRT yielded the greatest benefits. Cost-effectiveness was sensitive to NRT effectiveness and rate of mortality reduction using NRT. CONCLUSION: TB screening using an IGRA combined with NRT is more cost-effective among contacts who smoke. Positive smoking cessation interventions are recommended for their cost-effectiveness in low-incidence countries.

Cost-effectiveness of interferon-gamma release assay for systematic tuberculosis screening of healthcare workers in low-incidence countries.

BACKGROUND: Tuberculosis (TB) is one of the important occupationally acquired infectious diseases in low-incidence countries. Delays in TB diagnosis and treatment among healthcare workers (HCWs) result in costly large-scale TB contact screening among patients and other HCWs. AIM: To assess the cost-effectiveness of TB screening for HCWs using interferon-gamma release assays (IGRAs) compared with tuberculin skin test (TST) and chest x ray (CXR). METHODS: Markov models were constructed using a hospital payer perspective. The target populations were a hypothetical cohort of 30-year-old HCWs at the time of employment, and a hypothetical cohort of HCWs working on a high-risk ward until 60 years of age. Six strategies were modelled: TST, QuantiFERON-TB Gold In-Tube (QFT), T-SPOT.TB (T-SPOT), TST followed by QFT, TST followed by T-SPOT, and CXR. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs). Costs and QALYs gained per person screened were calculated. FINDINGS: QFT was the most cost-effective strategy at the 'willingness to pay' level of US$ 50,000/QALYs gained (at the time of employment: US$ 334.91, 21.071 QALYs; on a high-risk ward: US$ 1050.32, 20.968 QALYs; values for 2012). Cost-effectiveness was sensitive to latent TB infection (LTBI) rate and bacillus Calmette-Guérin vaccination rate. TST followed by QFT was more cost-effective than QFT when the LTBI rate was <0.026 at the time of employment and <0.08 on a high-risk ward. CONCLUSION: Systematic TB screening using QFT is cost-effective for screening HCWs, and is recommended in low-incidence countries.

Cost-effectiveness of interferon-gamma release assay for entry tuberculosis screening in prisons.

The incidence of active tuberculosis (TB) and latent tuberculosis infection (LTBI) in inmates and prison staff is higher than that in the general population. Mycobacterium tuberculosis-specific interferon-gamma release assays (IGRAs) provide more accurate diagnosis of M. tuberculosis infection with higher specificity than the tuberculin skin test (TST). To assess the cost effectiveness of QuantiFERON®-TB Gold In-Tube (QFT) compared to TST, TST followed by QFT and chest X-ray, we constructed Markov models using a societal perspective on the lifetime horizon. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness was compared. The QFT-alone strategy was the most cost-effective for entry TB screening in prisons in developed countries. Cost-effectiveness was not sensitive to the rates of BCG vaccination, LTBI, TB, HIV infection and multidrug-resistant TB. Entry TB screening using an IGRA in prisons should be considered on the basis of its cost-effectiveness by public health intervention.