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Cost-Effectiveness of Different Screening Strategies (Single or Dual) for the Diagnosis of Tuberculosis Infection in Healthcare Workers
M. Teresa del Campo MD PhD, Hadia Fouad MD, M. Marcela Solís-Bravo MD, M. Angeles Sánchez-Uriz MD, Ignacio Mahíllo-Fernández PhD MSc and Jaime Esteban MD PhD
Infection Control and Hospital Epidemiology
Vol. 33, No. 12 (December 2012), pp. 1226-1234
Published by: Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
Stable URL: http://www.jstor.org/stable/10.1086/668436
Page Count: 9
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Objective. To evaluate the cost-effectiveness of a dual strategy of tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT-G) for screening of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) and, as a secondary objective, to study relationships between TST results, QFT-G results, and sociodemographic factors.Design. Cross-sectional prospective study.Setting. University hospital in Madrid.Participants. A total of 103 HCWs.Methods. QFT-G was requested for all positive TST results; QFT-G results were compared with TST results, and their relationships with sociodemographic factors were analyzed. A cost-effectiveness analysis was conducted for the dual strategy (TST/QFT-G) and for TST or QFT alone, taking into account the indication of and compliance with isoniazid, the risk of hepatotoxicity, and postexposure tuberculosis.Results. Of all HCWs studied, 42.3% showed a positive result by QFT-G, and 49.5% had received bacille Calmette-Guérin (BCG) vaccination; no significant association was detected between BCG and QFT-G results. Increased TST was linked to higher positive QFT-G values (TST of 5–9.9 mm, 27.6%; TST of 15 mm or more, 56.5%; ). The probability of positive QFT-G results was 1.04 times higher for each year of age (odds ratio, 1.04 [95% confidence interval, 1.01–1.09]; ). The incremental cost per active TB case prevented was lower for TST/QFT-G than for the other strategies studied (€14,211 per 1,000 HCWs). The number of people treated for LTBI per case of active TB prevented (number needed to treat) for TST/QFT-G was lower than for TST alone (17.2 vs 95.3 and 88.7 with the 5- and 10-mm cutoff value, respectively) or QFT-G alone (69.6).Conclusions. Dual strategy with TST/QFT-G is more cost-effective than TST or QFT-G alone for the diagnosis of LTBI in HCWs.
© 2012 by The Society for Healthcare Epidemiology of America. All rights reserved.