Cost-Effectiveness of QuantiferonH-TB Gold-In-Tube Versus Tuberculin Skin Testing for Contact Screening and Treatment of Latent Tuberculosis Infection in Brazil

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dc.contributor.authorSteffen, Ricardo Ewbank
dc.contributor.authorCaetano, Rosângela
dc.contributor.authorPinto, Márcia
dc.contributor.authorChaves, Diogo
dc.contributor.authorFerrari, Rossini
dc.contributor.authorBastos, Mayara
dc.contributor.authorAbreu, Sandra Teixeira de
dc.contributor.authorMenzies, Dick
dc.contributor.authorTrajman, Anete
dc.date.accessioned2024-10-10T19:22:18Z
dc.date.available2024-10-10T19:22:18Z
dc.date.issued2013
dc.description.abstractBackground: 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.
dc.identifier.citationSteffen 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.
dc.identifier.otherDOI: 10.1371/journal.pone.0059546.
dc.identifier.urihttps://dspace.inc.saude.gov.br/handle/123456789/488
dc.language.isoen
dc.publisherPLoS One
dc.subjectBrazilen
dc.subjectContact Tracing / economicsen
dc.subjectContact Tracing / methodsen
dc.subjectCost-Benefit Analysisen
dc.subjectDecision Treesen
dc.subjectHumansen
dc.subjectInterferon-gamma Release Tests / economics*en
dc.subjectLatent Tuberculosis / diagnosisen
dc.subjectLatent Tuberculosis / drug therapyen
dc.subjectLatent Tuberculosis / economics*en
dc.subjectMass Screening / economicsen
dc.subjectModels, Econometricen
dc.subjectTuberculin Test / economics*en
dc.titleCost-Effectiveness of QuantiferonH-TB Gold-In-Tube Versus Tuberculin Skin Testing for Contact Screening and Treatment of Latent Tuberculosis Infection in Brazil
dc.typeArticle
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