Thorax
Volume 65, Issue 2, 2010, Pages 178-180

Cost-effectiveness of the NICE guidelines for screening for latent tuberculosis infection: The QuantiFERON-TB Gold IGRA alone is more cost-effective for immigrants from high burden countries (Article) (Open Access)

Hardy A.B. , Varma R. , Collyns T. , Moffitt S.J. , Mullarkey C. , Watson J.P.
  • a Leeds Teaching Hospitals NHS Trust, Department of Respiratory Machine, Beckett Street, Leeds LS9 7TF, United Kingdom
  • b Leeds Teaching Hospitals NHS Trust, Department of Respiratory Machine, Beckett Street, Leeds LS9 7TF, United Kingdom
  • c Leeds Teaching Hospitals NHS Trust, Department of Respiratory Machine, Beckett Street, Leeds LS9 7TF, United Kingdom
  • d Leeds Teaching Hospitals NHS Trust, Department of Respiratory Machine, Beckett Street, Leeds LS9 7TF, United Kingdom
  • e Leeds Teaching Hospitals NHS Trust, Department of Respiratory Machine, Beckett Street, Leeds LS9 7TF, United Kingdom
  • f Leeds Teaching Hospitals NHS Trust, Department of Respiratory Machine, Beckett Street, Leeds LS9 7TF, United Kingdom

Abstract

NICE (National Institute for Health and Clinical Excellence) guidelines for new entrant tuberculosis (TB) screening recommend chest x ray (CXR) for immigrants from countries with TB incidence >40/10 5 , and tuberculin skin test (TST) for people with normal CXR from very high TB prevalence countries. A revised screening policy using first-line QuantiFERON-TB Gold (QFT) in high risk immigrants was piloted in 2007. Initially, TST was offered to immigrants from countries with TB incidence 200-339/10 5 , and QFT to those from countries with incidence >340/10 5 . When increased resources became available, all immigrants from countries with TB incidence >200/10 5 had QFT. Those with positive QFT were invited for CXR. 1336 immigrant were invited for screening, with a 32% attendance rate. 280 patients had QFT, of which 38% were positive, with <2% being indeterminate. Using the NICE approach, the cost of screening these 280 immigrants would be £13 346.75 (£47.67 per immigrant) and would identify 83 cases of latent TB infection (LTBI). Using first-line QFT followed by CXR the cost was £9781.82 (£34.94 per immigrant) and identified 105 cases of LTBI. The cost to identify one case of LTBI following NICE guidelines would be £160.81 and using the present protocol was £93.16. For immigrants from high risk countries QFT blood testing followed by CXR is feasible for TB screening, cheaper than screening using the NICE guideline and identifies more cases of LTBI.

Author Keywords

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Index Keywords

controlled study thorax radiography priority journal major clinical study tuberculosis immigrant gamma interferon multicenter study clinical trial Article practice guideline human tuberculin test cost effectiveness analysis
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-76549121283&doi=10.1136%2fthx.2009.119677&partnerID=40&md5=f835be46134f9b0498f8f834ed23b96d
DOI: 10.1136/thx.2009.119677
ISSN: 00406376
Cited by: 54
Original Language: English