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1 School of Public Health, University of Düsseldorf, Düsseldorf, and 2 Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, and 3 Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, and 4 Center of Pneumology, Deaconess Hospital Rotenburg/Wümme, Rotenburg, Germany.
CORRESPONDENCE: R. Diel, School of Public Health, c/o Institute for Medical Sociology, Heinrich Heine University, P.O. box 101007, D-40001 Düsseldorf, Germany. Fax: 49 2118112390. E-mail: Roland.Diel{at}uni-duesseldorf.de
Keywords: Contact investigation, cost, cost-minimisation analysis, latent tuberculosis
Received: January 26, 2006
Accepted March 10, 2006
The aim of the present study was to perform cost-minimisation analysis of contact investigation from a public health perspective using the tuberculin skin test (TST) and a new blood assay, QuantiFERON-TB Gold (QFT-G).
A decision-analysis model simulated the costs of investigating a cohort of adult close tuberculosis contacts by the public health service following the current German guidelines over a period of 2 yrs. The economic outcomes were compared with alternative screening strategies. These were: 1) QFT-G instead of TST; 2) TST followed by QFT-G; and 3) TST followed by QFT-G in vaccinated (bacille Calmette–Guérin (BCG)) subjects.
In a base-case analysis, the costs of TST-based screening were 91.06 Euros (EUR)·contact-1, assuming a 1% tuberculosis-case-finding incidence. The least expensive strategy was TST screening plus subsequent QFT-G testing (52.05 EUR), resulting in a 43% cost reduction. Using QFT-G alone in BCG-vaccinated subjects who tested positive in the TST led to a 39% cost reduction. The savings using QFT-G alone instead of TST amounted to 29.77 EUR·contact-1. The results depended on the acquisition costs assumed and the proportion of positive results in TST-based screening.
Screening for tuberculosis by combining tuberculin skin testing and QuantiFERON-TB Gold markedly reduces public health costs compared with tuberculin skin test screening alone.
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