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

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  • Ricardo Ewbank Steffen
  • Rosângela Caetano
  • Márcia Pinto
  • Diogo Chaves
  • Rossini Ferrari
  • Mayara Bastos
  • Sandra Teixeira de Abreu
  • Dick Menzies
  • Anete Trajman

Abstract

Background: 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), QuantiFERON®-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.

Suggested Citation

  • Ricardo Ewbank Steffen & Rosângela Caetano & Márcia Pinto & Diogo Chaves & Rossini Ferrari & Mayara Bastos & Sandra Teixeira de Abreu & Dick Menzies & Anete Trajman, 2013. "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, Public Library of Science, vol. 8(4), pages 1-8, April.
    • Handle: RePEc:plo:pone00:0059546
    DOI: 10.1371/journal.pone.0059546
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    References listed on IDEAS

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    1. David W Dowdy & Maria C Lourenço & Solange C Cavalcante & Valeria Saraceni & Bonnie King & Jonathan E Golub & David Bishai & Betina Durovni & Richard E Chaisson & Susan E Dorman, 2008. "Impact and Cost-Effectiveness of Culture for Diagnosis of Tuberculosis in HIV-Infected Brazilian Adults," PLOS ONE, Public Library of Science, vol. 3(12), pages 1-8, December.
    2. Alice Zwerling & Marcel A. Behr & Aman Verma & Timothy F Brewer & Dick Menzies & Madhukar Pai, 2011. "The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices," Working Papers id:3921, eSocialSciences.
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