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Open Access Research article

QuantiFERON-TB gold in-tube implementation for latent tuberculosis diagnosis in a public health clinic: a cost-effectiveness analysis

Maunank Shah14*, Kathryn Miele1, Howard Choi1, Danielle DiPietro3, Maria Martins-Evora2, Vincent Marsiglia2 and Susan Dorman1

Author Affiliations

1 Johns Hopkins University School of Medicine, Baltimore, MD, USA

2 Baltimore City Health Department, Baltimore, MD, USA

3 Tulane University, New Orleans, LA, USA

4 Johns Hopkins University, School of Medicine, Division of Infectious Disease, Center for TB Research, 1503 East Jefferson St, Room 118, Baltimore, MD, 21231, USA

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BMC Infectious Diseases 2012, 12:360  doi:10.1186/1471-2334-12-360

Published: 19 December 2012

Abstract

Background

The tuberculin skin test (TST) has limitations for latent tuberculosis infection (LTBI) diagnosis in low-prevalence settings. Previously, all TST-positive individuals referred from the community to Baltimore City Health Department (BCHD) were offered LTBI treatment, after active TB was excluded. In 2010, BCHD introduced adjunctive QuantiFERON-TB Gold In-Tube (QFT-GIT) testing for TST-positive referrals. We evaluated costs and cost-effectiveness of this new diagnostic algorithm.

Methods

A decision-analysis model compared the strategy of treating all TST-positive referrals versus only those with positive results on adjunctive QFT-GIT testing. Costs were collected at BCHD, and Incremental Cost-Effectiveness Ratios (ICERs) were utilized to report on cost-effectiveness.

Results

QFT-GIT testing at BCHD cost $43.51 per test. Implementation of QFT-GIT testing was associated with an ICER of $1,202 per quality-adjusted life-year gained and was considered highly cost-effective. In sensitivity analysis, the QFT-GIT strategy became cost-saving if QFT-GIT sensitivity increased above 92% or if less than 3.5% of individuals with LTBI progress to active TB disease.

Conclusions

LTBI screening with TST in low-prevalence settings may lead to overtreatment and increased expenditures. In this public health clinic, additional QFT-GIT testing of individuals referred for a positive TST was cost-effective.

Keywords:
Tuberculosis; Diagnosis; Interferon-gamma release assay; Latent tuberculosis; Implementation