In 2005, San Francisco did a cost-effectiveness analysis which showed that a single IGRA test is the best strategy from a societal perspective. From a health system perspective, the hybrid strategy was the least costly (similar to Canadian and European cost analysis). When examining the costs of the QFT-GIT and T-SPOT, they found QFT-GIT with full laboratory automation was least costly at $25.09 per test compared to T-SPOT at $57.59 per test. The T-SPOT was really not an option for use in 2005 because it had yet to be approved by the FDA and was more than double the cost of the QFT test. A second analysis of cost was done this year using actual laboratory costs, minimal standard billing and reimbursement rates, and operational loss of patients based on SF surveillance data on referrals, evaluation and treatment. When chest X-ray savings and state and federal insurance reimbursement (14% and 10% of patients served respectively) were calculated into the cost of the QFT in SF, the actual cost for 10 000 QFT-GIT tests per year ranged from a net cost of $30 549 to a net savings of $101 648 (variation dependent on CXR billing rates). If additional savings from unneeded medical evaluations and LTBI treatment from the lower QFT-positive prevalence (65% less than TST) were included, the range of cost savings per year was $328 068 to $460 265. The calculations may underestimate the cost savings because the following were not included: follow-up on unread tests; second clinic visits; staff time for TST readings; and handling adverse effects from INH. Accordingly, in San Francisco, QFT pays for itself and is likely cost saving. QFT testing is sustainable with a 24% government reimbursement rate covering the cost of QFT kits. The referral rate to the TB Clinic from immigrant clinics has dropped significantly since switching to IGRAs, and society benefits from the convenience and specificity of the QFT. © 2010 The Union.

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