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Eur Respir J 2006, doi:10.1183/09031936.06.00011806
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ORIGINAL ARTICLE |
Cost optimization of screening for latent tuberculosis in close contacts
1 School of Public Health, University of Düsseldorf, Germany
2 Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany
3 Research Center Borstel, Division of Clinical Infectious Diseases, Germany
4 Center of Pneumology, Deaconess Hospital Rotenburg/Wümme, Germany
* To whom correspondence should be addressed. E-mail: Roland.Diel{at}uni-duesseldorf.de.
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Abstract |
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To perform a cost-minimisation analysis of contact investigation from a Public Health perspective by 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 TB contacts by the Public Health Service following the current German guidelines over a period of two years. The economic outcomes were compared with alternative screening strategies. These were: (i) QFT-G instead of TST, (ii) TST followed by QFT-G, and (iii) TST followed by QFT-G in BCG-vaccinated subjects.
In a base-case analysis, the costs of TST-based screening were 
91.06 per contact, assuming a 1% TB case-finding incidence. The least expensive strategy was TST screening plus subsequent QFT-G testing ( 52.05) resulting in a 43% cost reduction. Using QFT-G only in BCG-vaccinated subjects who tested positive in the TST led to a 39% cost reduction. The savings by using QFT-G alone instead of TST amounted to 29.77 per contact. The results depended on the acquisition costs assumed and the proportion of positive results in TST-based screening.
Screening for TB by combining TST and QFT-G markedly reduces Public Health costs compared with TST screening only.
Keywords: Contact investigation, cost, cost-minimisation analysis, latent tuberculosis
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