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

ABSTRACT

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.