Cost-effectiveness of testing for latent tuberculosis infection in people with HIV.
AIDS
; 36(1): 1-9, 2022 01 01.
Article
en En
| MEDLINE
| ID: mdl-34873091
ABSTRACT
OBJECTIVE:
The aim of this study was to estimate the cost-effectiveness of screening strategies for predicting LTBI that progresses to active tuberculosis (TB) in people with HIV.DESIGN:
We developed a decision-analytical model that constituted a decision tree covering diagnosis of LTBI and a Markov model covering progression to active TB. The model represents the lifetime experience following testing for LTBI, and discounting costs, and benefits at 3.5% per annum in line with UK standards. We undertook probabilistic and one-way sensitivity analyses.SETTING:
UK National Health Service and Personal Social Service perspective in a primary care setting.PARTICIPANTS:
Hypothetical cohort of adults recently diagnosed with HIV.INTERVENTIONS:
Interferon-gamma release assays and tuberculin skin test. MAIN OUTCOMEMEASURE:
Cost per quality-adjusted life year (QALY).RESULTS:
All strategies except T-SPOT.TB were cost-effective at identifying LTBI, with the QFT-GIT-negative followed by TST5mm strategy being the most costly and effective. Results indicated that there was little preference between strategies at a willingness-to-pay threshold of £20â000. At thresholds above £40â000 per QALY, there was a clear preference for the QFT-GIT-negative followed by TST5mm, with a probability of 0.41 of being cost-effective. Results showed that specificity for QFT-GIT and TST5mm were the main drivers of the economic model.CONCLUSION:
Screening for LTBI has important public health and clinical benefits. Most of the strategies are cost-effective. These results should be interpreted with caution because of the paucity of studies included in the meta-analysis of test accuracy studies. Additional high-quality primary studies are needed to have a definitive answer about, which strategy is the most effective.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Infecciones por VIH
/
Tuberculosis Latente
Tipo de estudio:
Diagnostic_studies
/
Guideline
/
Health_economic_evaluation
/
Prognostic_studies
/
Systematic_reviews
Límite:
Adult
/
Humans
Idioma:
En
Revista:
AIDS
Asunto de la revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Año:
2022
Tipo del documento:
Article