Cost-Effectiveness of QuantiferonH-TB Gold-In-Tube Versus Tuberculin Skin Testing for Contact Screening and Treatment of Latent Tuberculosis Infection in Brazil
Cost-Effectiveness of QuantiferonH-TB Gold-In-Tube Versus Tuberculin Skin Testing for Contact Screening and Treatment of Latent Tuberculosis Infection in Brazil
Data
2013
Autores
Steffen, Ricardo Ewbank
Caetano, Rosângela
Pinto, Márcia
Chaves, Diogo
Ferrari, Rossini
Bastos, Mayara
Abreu, Sandra Teixeira de
Menzies, Dick
Trajman, Anete
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS One
Resumo
Background: Latent tuberculosis infection (LTBI) is a reservoir for new TB cases. Isoniazid preventive therapy (IPT) reduces
the risk of active TB by as much as 90%, but LTBI screening has limitations. Unlike tuberculin skin testing (TST), interferon-
gamma release assays are not affected by BCG vaccination, and have been reported to be cost-effective in low-burden
countries. The goal of this study was to perform a cost-effectiveness analysis from the health system perspective, comparing
three strategies for LTBI diagnosis in TB contacts: tuberculin skin testing (TST), QuantiFERONH-TB Gold-in-Tube (QFT-GIT)
and TST confirmed by QFT-GIT if positive (TST/QFT-GIT) in Brazil, a middle-income, high-burden country with universal BCG
coverage.
Methodology/Principal Findings: Costs for LTBI diagnosis and treatment of a hypothetical cohort of 1,000 adult
immunocompetent close contacts were considered. The effectiveness measure employed was the number of averted TB
cases in two years. Health system costs were US$ 105,096 for TST, US$ 121,054 for QFT-GIT and US$ 101,948 for TST/QFT-
GIT; these strategies averted 6.56, 6.63 and 4.59 TB cases, respectively. The most cost-effective strategy was TST (US$ 16,021/
averted case). The incremental cost-effectiveness ratio was US$ 227,977/averted TB case for QFT-GIT. TST/QFT-GIT was
dominated.
Conclusions: Unlike previous studies, TST was the most cost-effective strategy for averting new TB cases in the short term.
QFT-GIT would be more cost-effective if its costs could be reduced to US$ 26.95, considering a TST specificity of 59% and
US$ 18 considering a more realistic TST specificity of 80%. Nevertheless, with TST, 207.4 additional people per 1,000 will be
prescribed IPT compared with QFT.
Description
Palavras-chave
Brazil, Contact Tracing / economics, Contact Tracing / methods, Cost-Benefit Analysis, Decision Trees, Humans, Interferon-gamma Release Tests / economics*, Latent Tuberculosis / diagnosis, Latent Tuberculosis / drug therapy, Latent Tuberculosis / economics*, Mass Screening / economics, Models, Econometric, Tuberculin Test / economics*
Citação
Steffen RE, Caetano R, Pinto M, Chaves D, Ferrari R, Bastos M, de Abreu ST, Menzies D, Trajman A. Cost-effectiveness of Quantiferon®-TB Gold-in-Tube versus tuberculin skin testing for contact screening and treatment of latent tuberculosis infection in Brazil. PLoS One. 2013 Apr 4;8(4):e59546. doi: 10.1371/journal.pone.0059546.