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Original Research: RESPIRATORY INFECTIONS |

Cost-effectiveness of Interferon-γ Release Assay Screening for Latent Tuberculosis Infection Treatment in Germany*

Roland Diel, MD, MPH; Albert Nienhaus, MD, MPH; Robert Loddenkemper, MD, FCCP
Author and Funding Information

*From the School of Public Health (Dr. Diel), University of Düsseldorf, Düsseldorf, Germany; Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (Dr. Nienhaus), Hamburg, Germany; and the German Central Committee Against Tuberculosis (Dr. Loddenkemper), Berlin, Germany.

Correspondence to: Roland Diel, MD, MPH, School of Public Health, c/o Institute for Medical Sociology, Heinrich Heine University, Post Box 101007, D-40001 Düsseldorf, Germany; e-mail: Roland.Diel@uni-duesseldorf.de



Chest. 2007;131(5):1424-1434. doi:10.1378/chest.06-2728
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Objectives: To assess the cost-effectiveness of the new QuantiFERON-TB Gold In-Tube (QFT-G) [Cellestis; Carnegie, VIC, Australia] assay for screening and treating of persons who have had close contact with tuberculosis (TB) patients and are suspected of having latent tuberculosis infection (LTBI) [hereafter called close-contacts] in Germany.

Methods: The health and economic outcomes of isoniazid treatment of 20-year-old close-contacts were compared in a Markov model over a period of 20 years, using two different cutoff values for the tuberculin skin test (TST), the QFT-G assay alone, or the QFT-G assay as a confirmatory test for the TST results.

Results: QFT-G assay-based treatment led to cost savings of $542.9 and 3.8 life-days gained per LTBI case. TST-based treatment at a 10-mm induration size cutoff gained $177.4 and 2.0 life-days gained per test-positive contact. When the cutoff induration size for the TST was reduced to 5 mm, the incremental cost-effectiveness ratio fell below the willingness-to-pay threshold ($30,170 per life-years gained) but resulted in unnecessary treatment of 77% of contacts owing to false-positive TST results. Combination with the 5-mm induration size TST cutoff value compared to the results of the QFT-G assay alone reduced the total costs per 1,000 contacts by 1.8% to $222,869. The number treated to prevent 1 TB case was 22 for the two QFT-G assay-based procedures, 40 for the TST at a cutoff induration size of 10 mm, and 96 for the TST at a cutoff induration size of 5 mm. When the sensitivity rates of the TST and the QFT-G assay were compounded, the QFT-G assay strategy alone was slightly less costly (0.6%) than the two-step approach.

Conclusions: Using the QFT-G assay, but especially combining the QFT-G assay following the TST screening of close-contacts at a cutoff induration size of 5 mm before LTBI treatment is highly cost-effective in reducing the disease burden of TB.

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