Latent tuberculosis infection screening of adult close contacts: a cost-utility analysis
File(s)
Published version (early view)
Author(s)
Type
Journal Article
Abstract
Background
The 2016 National Institute for Health and Care Excellence guidelines recommended the tuberculin skin test (TST), at a 5-mm induration size cut-off, for the diagnosis of latent tuberculosis infection (LTBI) among adult close contacts of active tuberculosis (TB) cases. This study analysed a well characterised cohort of adult close contacts in London and assess the cost-effectiveness of LTBI screening strategies with combinations of TST and interferon-gamma release assays (IGRAs) in a decision-analytic model.
Methods
Close contacts of pulmonary TB cases who were tested with TST and IGRA between January 2008 and December 2010 were retrospectively reviewed. Using a NHS perspective and lifetime horizon, a decision-analytic Markov model was used to compare costs and quality-adjusted life years (QALYs) associated with five screening strategies followed by LTBI treatment: TST alone, IGRA (QuantiFERON-TB Gold In-Tube [QFT] or T-SPOT.TB [T-SPOT]) alone, and TST positive followed by IGRA.
Results
This study included 381 asymptomatic close contacts aged 18 to 65 years (mean 35.2 (sd: 11.3)). 75.3% had received BCG vaccination. Among the five strategies, for a willingness to pay threshold of £25 000 and using incremental net monetary benefit (INMB) with TST as comparator, the IGRA alone strategies were the most cost-effective, marginally QFT over T-SPOT (QFT £214; T-SPOT £199).
Conclusion
Single-step IGRA, particularly QuantiFERON, is preferable for LTBI screening of adult close contacts of pulmonary TB cases.
The 2016 National Institute for Health and Care Excellence guidelines recommended the tuberculin skin test (TST), at a 5-mm induration size cut-off, for the diagnosis of latent tuberculosis infection (LTBI) among adult close contacts of active tuberculosis (TB) cases. This study analysed a well characterised cohort of adult close contacts in London and assess the cost-effectiveness of LTBI screening strategies with combinations of TST and interferon-gamma release assays (IGRAs) in a decision-analytic model.
Methods
Close contacts of pulmonary TB cases who were tested with TST and IGRA between January 2008 and December 2010 were retrospectively reviewed. Using a NHS perspective and lifetime horizon, a decision-analytic Markov model was used to compare costs and quality-adjusted life years (QALYs) associated with five screening strategies followed by LTBI treatment: TST alone, IGRA (QuantiFERON-TB Gold In-Tube [QFT] or T-SPOT.TB [T-SPOT]) alone, and TST positive followed by IGRA.
Results
This study included 381 asymptomatic close contacts aged 18 to 65 years (mean 35.2 (sd: 11.3)). 75.3% had received BCG vaccination. Among the five strategies, for a willingness to pay threshold of £25 000 and using incremental net monetary benefit (INMB) with TST as comparator, the IGRA alone strategies were the most cost-effective, marginally QFT over T-SPOT (QFT £214; T-SPOT £199).
Conclusion
Single-step IGRA, particularly QuantiFERON, is preferable for LTBI screening of adult close contacts of pulmonary TB cases.
Date Issued
2025-02-13
Date Acceptance
2024-11-25
Citation
ERJ Open Research, 2025
ISSN
2312-0541
Publisher
European Respiratory Society
Journal / Book Title
ERJ Open Research
Copyright Statement
©The authors 2025. This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org
License URL
Identifier
10.1183/23120541.00818-2024)
Publication Status
Published online
Date Publish Online
2025-02-13