Cost-effectiveness of Interferon Gamma Release Assays vs Tuberculin Skin Tests in Health Care Workers
Cost-effectiveness of Interferon Gamma Release Assays vs Tuberculin Skin Tests in Health Care Workers
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DOI：
10.1001/archinternmed.2008.524
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发表时间：
2009-01-26
影响因子：
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通讯作者：
Eckman, Mark H.
中科院分区：
文献类型：
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作者：
de Perio, Marie A.;Tsevat, Joel;Eckman, Mark H.
背景资料：干扰素γ释放试验（IGRAs）为结核菌素皮肤试验（TSTs）提供了诊断潜伏性结核感染（LTBI）的替代方法。与TST不同，IGRA只需要一次患者就诊，不受既往BCG疫苗接种的影响，具有更高的特异性。在美国食品药品监督管理局批准的2种IGRA中，较新的QuantiFERON-TB Gold in Tube检测（QFT-GIT）需要的手动处理时间比QuantiFERON-TB Gold检测（QFT-G）更少。我们比较了QFT-G，QFT-GIT，TST检测LTBI在新的卫生保健工作者（HCWs.Methods）的成本效益：马尔可夫状态转换决策分析模型，使用社会的角度和寿命范围构建了比较成本和质量调整生命年（QSTs）与3个策略假设35岁的HCWs有或没有事先接种卡介苗。直接和间接的成本和概率是基于制造商的数据，国家退伍军人健康管理局的记录，和出版的文献。未来成本和季度成本以每年3%的贴现率贴现。结果：两种IGRA均比TST更有效且成本更低，无论HCW是否已接种BCG。与QFT-GIT相比，QFT-G的增量成本效益比对于未接种BCG的HCW为14092美元/QALY，对于接种BCG的HCW为103047美元/QALY。没有LTBI的患病率，TST成为最有效或成本最低的策略。如果QFT-GIT的敏感性超过了QFT-G，那么QFT-GIT是最有效和最便宜的strategy.Conclusion：使用QFT-G和QFT-GIT导致上级临床结果和较低的成本比TST，并应考虑在筛选非卡介苗接种和卡介苗接种的新HCWs的LTBI。
Background: Interferon gamma release assays (IGRAs) offer alternatives to tuberculin skin tests (TSTs) for diagnosing latent tuberculosis infection (LTBI). Unlike TSTs, IGRAs require only a single patient visit and are not affected by prior BCG vaccination, providing greater specificity. Of 2 Food and Drug Administration approved IGRAs, the newer QuantiFERON-TB Gold in Tube test (QFT-GIT) requires less manual processing time than the QuantiFERON-TB Gold test (QFT-G). We compared the cost-effectiveness of the QFT-G, QFT-GIT, and TST for detecting LTBI in new health care workers (HCWs).Methods: A Markov state-transition decision analytic model using the societal perspective and lifetime horizon was constructed to compare costs and quality-adjusted life-years (QALYs) associated with the 3 strategies for hypothetical 35-year-old HCWs with or without prior BCG vaccination. Direct and indirect costs and probabilities were based on manufacturer data, national Veterans Health Administration records, and the published literature. Future costs and QALYs were discounted at 3% per year. Results: Both IGRAs were more effective and less costly than the TST, whether or not the HCW had been vaccinated with BCG previously. The incremental cost-effectiveness ratio of the QFT-G compared with the QFT-GIT was $14092/QALY for non-BCG-vaccinated HCWs and $103047/QALY for BCG-vaccinated HCWs. There was no prevalence of LTBI at which the TST became the most effective or least costly strategy. If the sensitivity of the QFT-GIT exceeds that of the QFT-G, then the QFT-GIT is the most effective and least costly strategy.Conclusion: Use of the QFT-G and QFT-GIT leads to superior clinical outcomes and lower costs than the TST and should be considered in screening non-BCG-vaccinated and BCG-vaccinated new HCWs for LTBI.