Interferon-γ Release Assays Screening for Latent Tuberculosis Screening: A Cost-Effectiveness Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Qunfei ¹ , WANG Li ¹ ,  LI Youping ¹ , YANG Xiaoyan ¹ , LI Dan ² , WANG Yihan ² , HOU Qingtao ² , LEI Junhao ²

1.Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;2.West China School of Medicine, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Youping, Email: scliyouping@sohu.com

Keywords：

Latent tuberculosis infection; Interferon-γ release assay; Cost-effectiveness analysis; Screening

DOI：

10.7507/1672-2531.20110132

Video：

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Objective 　To evaluate the cost-effectiveness of three LTBI screening strategies: the tuberculin skin test (TST), the T-SPOT.TB and the combination of TST and T-SPOT (TST+T.SPOT), to provide economic evidence for T.SPOT application in China.
Methods 　A decision analysis model evaluated three strategies among a cohort of 1000 tuberculosis (TB) close contacts, using incremental cost-effectiveness of prevention a active TB patient (1 year post contact). Meta analyses were conducted to calculate the key parameters of T.SPOT and TST. The official data or literature was searched and the unaccessible data was to specify other parameters, such as cost, LTBI prevalence, etc. The one-way sensitivity analysis was performed, varying key parameters over a wide range of reasonable values to evaluate the impact of data uncertainties and to determine the robustness of our overall conclusion.
Results 　a) As for the total cost, the TST+T.SPOT strategy (?212 213.81 per 1 000 contacts) cost the least, while the single T.SPOT strategy cost the most; b) Subsequently, the TST+T.SPOT strategy required less contacts to be treated to prevent an active case of TB (8.31) than the single TST strategy (25.67); c) the TST+T.SPOT strategy shared the most cost-effectiveness (?3 063.50 per active TB case prevented) than the single TST or T.SPOT strategy; and d) The results of one-way sensitivity analyses showed that cost-effectiveness values were sensitive to changes in LTBI prevalence ( gt;60%), Sen and Spn of TST test ( gt;70%), with the single TST being superior to the single T.SPOT.
Conclusion 　The Single T.SPOT strategy enjoys the most cases prevented from active TB, while the TST+S.SPOT strategy is the most cost-effective. The conclusion is sensitive to a few parameters, such as LTBI prevalence, but the TST+T.SPOT strategy is always the best.

Citation： CHEN Qunfei,WANG Li,LI Youping,YANG Xiaoyan,LI Dan,WANG Yihan,HOU Qingtao,LEI Junhao. Interferon-γ Release Assays Screening for Latent Tuberculosis Screening: A Cost-Effectiveness Analysis. Chinese Journal of Evidence-Based Medicine, 2011, 11(7): 768-774. doi: 10.7507/1672-2531.20110132 Copy

1.	1 Sadatsafavi M, Najafzadeh M. Cost-optimisation of diagnosis for latent tuberculosis in closen contacts. European Respiratory Journal , 2006, 28(6): 1285.
2.	Economic Evaluation Database, 2007(1).
3.	Pooran A, Booth H, Miller RF, et al . Different diagnosis strategies (single or dual) for the diagnosis of suspected latent tuberculosis: A cost effectiveness analysis. BMC Pulmonary Medicine , 2010: 10.
4.	Linertova R, Alvarez-Leon EE, Garcia-Perez L, et al . Costs of QuantiFERON(registered trademark)-TB Gold versus tuberculin skin test in spanish healthcare workers. Journal of Hospital Infection , 2010, 75(1): 52-55.
5.	Kowada A, Takahashi O, Shimbo T, et al . Cost effectiveness of interferon-(gamma) release assay for tuberculosis contact diagnosis in Japan. Molecular Diagnosis and Therapy , 2008, 12(4): X235-251.
6.	Fox BD, Kramer MR, Mor Z, et al . The QuantiFERON(registered trademark)-TB-GOLD assay for tuberculosis diagnosis in healthcare workers: A cost-comparison analysis. Lung , 2009, 187(6): 413-419.
7.	Diel R, Schaberg T, Loddenkemper R, et al . Enhanced cost-benefit analysis of strategies for LTBI diagnosis and INH chemoprevention in Germany. Respiratory Medicine , 2009, 103(12): 1838-1853.
8.	Diel R, Wrighton-Smith P, Zellweger JP. Cost-effectiveness of interferon-(gamma) release assay testing for the treatment of latent tuberculosis. European Respiratory Journal , 2007, 30(2): 321-332.
9.	Diel R, Nienhaus A, Lange C, et al . Cost-optimisation of diagnosis for latent tuberculosis in close contacts. European Respiratory Journal , 2006, 28(1): 35-44.
10.	De Perio MA, Tsevat J, Roselle GA, et al . Cost-effectiveness of interferon gamma release assays vs tuberculin skin tests in health care workers. Archives of Internal Medicine , 2009, 169(2): 179-187.
11.	Burgos JL, Kahn JG, Strathdee SA, et al . Targeted diagnosis and treatment for latent tuberculosis infection using QuantiFERON(registered trademark)-TB Gold is cost-effective in Mexico. International Journal of Tuberculosis and Lung Disease , 2009, 13(8): 962-968.
12.	Abdalhamid B, Hinrichs SH, Garrett JL, et al . Utilization of the QuantiFERON-TB gold test in a two-step process with the tuberculin skin test to evaluate health care workers for latent tuberculosis. Journal of Clinical Microbiology , 2010, 48(8): 2955-2956.
13.	Wrighton-Smith P, Zellweger JP. Direct costs of three models for the diagnosis of latent tuberculosis infection. European Respiratory Journal , 2006: 28(1): 45-50.
14.	深圳市卫生和人口计划生育委员会. 深圳医疗服务项目价格. http://www.sz.gov.cn/gsj/szsgsjwjj/zxbs_gsj/fwxxcx/ylsfzc/.
15.	浙江省物价局, 浙江省卫生厅. 浙江省医疗服务项目价格. http://www.nbdpc.gov.cn/wjgl-285.html.
16.	陕西省物价局, 陕西省卫生厅陕西省医疗服务项目价格. http://zw.sxhealth.gov.cn/pricesearch/yxyx.htm.
17.	北京市发展与改革委员会. 北京医疗服务项目价格. http://www.alyisheng.com/hospital/22754-6.html.
18.	贵州省物价局, 贵州省卫生厅. 贵州省医疗服务项目价格. http://www.gzwst.gov.cn/SysHTML/ArticleHTML/14856_1.shtml.
19.	辽宁省物价局, 辽宁省卫生厅. 辽宁省医疗服务项目价格. http://www.cpic.gov.cn/fgw/Proxyservlet?server=e450&urls_count=1&url=drug/ylsf/liaoning/liaoning.htm.
20.	谢希, 陈进伟, 高洁生, 等. 结核感染T细胞斑点试验在结核诊断中的应用. 临床内科杂志, 2010, 27(6): 396-399.
21.	陶叶海, 金法祥. 酶联免疫斑点技术在结核病诊断中的应用. 上海预防医学, 2010, 22(8): 421-422.
22.	邱丽华, 王学东, 周洪顺, 等. 以ESAT-6, CFP-10 为基础的ELISPOT 试验, 血清TB-SA 抗体检测, PPD 试验在肺结核诊断中应用价值研究. 中国防痨杂志, 2009, 31(7): 434-436.
23.	李峤珂, 吴雪琼, 阳幼荣, 等. T spot-Tb试剂盒在结核病临床诊断中的应用价值. 实用医学杂志, 2010, (17): 3117-3119.
24.	Su J, Zhu L, Cheng J, et al . Application of T-spot. TB test in the diagnosis of tuberculosis. Chinese Journal of Infection and Chemotherapy , 2010: 10(4): 297-299.
25.	王玉春. 结核菌素强阳性预防性治疗短期效果观察. 临床肺科杂志, 2010, 15(10): 1495-1496.
26.	王森, 张文宏. 潜伏性结核感染的诊治进展. 微生物与感染, 2008, 3(4): 234-237.
27.	朱俊芳, 刘伟江, 刘柏辉, 等. 大中专学生预防性抗结核治疗效果调查分析. 赣南医学院学报, 2008, 28(3): 432-433.
28.	郑立新, 龙和平, 郑绍军, 等. 学校结核病暴发后预防治疗效果观察. 河北医药, 2009, 31(23): 3306.
29.	杨运亭, 赵清芳, 宁海燕, 等. 家庭密切接触者结核感染的预防性治疗效果观察. 中国现代药物应用, 2009, 3(14): 209-210.
30.	孟薇. 结核病高危人群疾病预防疗效分析. 中外医疗, 2009, 28(9): 31.
31.	辛梅平, 孙业建, 李明霞, 等. 结核感染的异烟肼预防性治疗. 青岛医药卫生, 2009, 41(4): 283-284.
32.	雷建平. 常见抗结核药物的肝损害及其处理. 江西医药, 2001, 36(2): 144-147.
33.	Diel R, Nienhaus A, Loddenkemper R. Cost-effectiveness of interferon-gamma release assay diagnosis for latent tuberculosis infection treatment in Germany (Structured abstract). NHS.
34.	Oxlade O, Schwartzman K, Menzies D, et al . 在高收入国家的γ干扰素释放试验与结核病筛查:成本-效益分析. 国际结核病与肺部疾病杂志, 2007, 2(1): 17-29.

1. 1 Sadatsafavi M, Najafzadeh M. Cost-optimisation of diagnosis for latent tuberculosis in closen contacts. European Respiratory Journal , 2006, 28(6): 1285.
2. Economic Evaluation Database, 2007(1).
3. Pooran A, Booth H, Miller RF, et al . Different diagnosis strategies (single or dual) for the diagnosis of suspected latent tuberculosis: A cost effectiveness analysis. BMC Pulmonary Medicine , 2010: 10.
4. Linertova R, Alvarez-Leon EE, Garcia-Perez L, et al . Costs of QuantiFERON(registered trademark)-TB Gold versus tuberculin skin test in spanish healthcare workers. Journal of Hospital Infection , 2010, 75(1): 52-55.
5. Kowada A, Takahashi O, Shimbo T, et al . Cost effectiveness of interferon-(gamma) release assay for tuberculosis contact diagnosis in Japan. Molecular Diagnosis and Therapy , 2008, 12(4): X235-251.
6. Fox BD, Kramer MR, Mor Z, et al . The QuantiFERON(registered trademark)-TB-GOLD assay for tuberculosis diagnosis in healthcare workers: A cost-comparison analysis. Lung , 2009, 187(6): 413-419.
7. Diel R, Schaberg T, Loddenkemper R, et al . Enhanced cost-benefit analysis of strategies for LTBI diagnosis and INH chemoprevention in Germany. Respiratory Medicine , 2009, 103(12): 1838-1853.
8. Diel R, Wrighton-Smith P, Zellweger JP. Cost-effectiveness of interferon-(gamma) release assay testing for the treatment of latent tuberculosis. European Respiratory Journal , 2007, 30(2): 321-332.
9. Diel R, Nienhaus A, Lange C, et al . Cost-optimisation of diagnosis for latent tuberculosis in close contacts. European Respiratory Journal , 2006, 28(1): 35-44.
10. De Perio MA, Tsevat J, Roselle GA, et al . Cost-effectiveness of interferon gamma release assays vs tuberculin skin tests in health care workers. Archives of Internal Medicine , 2009, 169(2): 179-187.
11. Burgos JL, Kahn JG, Strathdee SA, et al . Targeted diagnosis and treatment for latent tuberculosis infection using QuantiFERON(registered trademark)-TB Gold is cost-effective in Mexico. International Journal of Tuberculosis and Lung Disease , 2009, 13(8): 962-968.
12. Abdalhamid B, Hinrichs SH, Garrett JL, et al . Utilization of the QuantiFERON-TB gold test in a two-step process with the tuberculin skin test to evaluate health care workers for latent tuberculosis. Journal of Clinical Microbiology , 2010, 48(8): 2955-2956.
13. Wrighton-Smith P, Zellweger JP. Direct costs of three models for the diagnosis of latent tuberculosis infection. European Respiratory Journal , 2006: 28(1): 45-50.
14. 深圳市卫生和人口计划生育委员会. 深圳医疗服务项目价格. http://www.sz.gov.cn/gsj/szsgsjwjj/zxbs_gsj/fwxxcx/ylsfzc/.
15. 浙江省物价局, 浙江省卫生厅. 浙江省医疗服务项目价格. http://www.nbdpc.gov.cn/wjgl-285.html.
16. 陕西省物价局, 陕西省卫生厅陕西省医疗服务项目价格. http://zw.sxhealth.gov.cn/pricesearch/yxyx.htm.
17. 北京市发展与改革委员会. 北京医疗服务项目价格. http://www.alyisheng.com/hospital/22754-6.html.
18. 贵州省物价局, 贵州省卫生厅. 贵州省医疗服务项目价格. http://www.gzwst.gov.cn/SysHTML/ArticleHTML/14856_1.shtml.
19. 辽宁省物价局, 辽宁省卫生厅. 辽宁省医疗服务项目价格. http://www.cpic.gov.cn/fgw/Proxyservlet?server=e450&urls_count=1&url=drug/ylsf/liaoning/liaoning.htm.
20. 谢希, 陈进伟, 高洁生, 等. 结核感染T细胞斑点试验在结核诊断中的应用. 临床内科杂志, 2010, 27(6): 396-399.
21. 陶叶海, 金法祥. 酶联免疫斑点技术在结核病诊断中的应用. 上海预防医学, 2010, 22(8): 421-422.
22. 邱丽华, 王学东, 周洪顺, 等. 以ESAT-6, CFP-10 为基础的ELISPOT 试验, 血清TB-SA 抗体检测, PPD 试验在肺结核诊断中应用价值研究. 中国防痨杂志, 2009, 31(7): 434-436.
23. 李峤珂, 吴雪琼, 阳幼荣, 等. T spot-Tb试剂盒在结核病临床诊断中的应用价值. 实用医学杂志, 2010, (17): 3117-3119.
24. Su J, Zhu L, Cheng J, et al . Application of T-spot. TB test in the diagnosis of tuberculosis. Chinese Journal of Infection and Chemotherapy , 2010: 10(4): 297-299.
25. 王玉春. 结核菌素强阳性预防性治疗短期效果观察. 临床肺科杂志, 2010, 15(10): 1495-1496.
26. 王森, 张文宏. 潜伏性结核感染的诊治进展. 微生物与感染, 2008, 3(4): 234-237.
27. 朱俊芳, 刘伟江, 刘柏辉, 等. 大中专学生预防性抗结核治疗效果调查分析. 赣南医学院学报, 2008, 28(3): 432-433.
28. 郑立新, 龙和平, 郑绍军, 等. 学校结核病暴发后预防治疗效果观察. 河北医药, 2009, 31(23): 3306.
29. 杨运亭, 赵清芳, 宁海燕, 等. 家庭密切接触者结核感染的预防性治疗效果观察. 中国现代药物应用, 2009, 3(14): 209-210.
30. 孟薇. 结核病高危人群疾病预防疗效分析. 中外医疗, 2009, 28(9): 31.
31. 辛梅平, 孙业建, 李明霞, 等. 结核感染的异烟肼预防性治疗. 青岛医药卫生, 2009, 41(4): 283-284.
32. 雷建平. 常见抗结核药物的肝损害及其处理. 江西医药, 2001, 36(2): 144-147.
33. Diel R, Nienhaus A, Loddenkemper R. Cost-effectiveness of interferon-gamma release assay diagnosis for latent tuberculosis infection treatment in Germany (Structured abstract). NHS.
34. Oxlade O, Schwartzman K, Menzies D, et al . 在高收入国家的γ干扰素释放试验与结核病筛查:成本-效益分析. 国际结核病与肺部疾病杂志, 2007, 2(1): 17-29.

Chinese Journal of Evidence-Based Medicine

Interferon-γ Release Assays Screening for Latent Tuberculosis Screening: A Cost-Effectiveness Analysis

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