Cost Effectiveness of Interferon-Gamma Release Assay versus Chest X-Ray for Tuberculosis Screening of BCG-Vaccinated Eld
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ORIGINAL RESEARCH ARTICLE
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Cost Effectiveness of Interferon-Gamma Release Assay versus Chest X-Ray for Tuberculosis Screening of BCG-Vaccinated Elderly Populations Akiko Kowada,1 Gautam A. Deshpande,2 Osamu Takahashi,3 Takuro Shimbo4 and Tsuguya Fukui3 1 2 3 4
Bunkyo City Public Health Center, Bunkyo City, Tokyo, Japan Department of Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA Department of General Internal Medicine, St. Luke’s International Hospital, Tokyo, Japan Department of Clinical Research and Informatics, International Clinical Research Center, Research Institute, International Medical Center, Tokyo, Japan
Abstract
Background: The prevalence of tuberculosis (TB) in the elderly is higher than that in the general population, and elderly populations are considered a high-risk group. Currently, annual TB screening of Bacille Calmette-Gue´rin (BCG)-vaccinated people aged over 65 years is performed by an annual chest x-ray examination (CXR) in Japan. Interferon-gamma release assays (QuantiFERON-TB Gold and QuantiFERON-TB Gold In-Tube [QFT]) are new alternatives to the tuberculin skin test to diagnose latent TB infection (LTBI) that have no cross-reactivity with the BCG vaccine. We evaluated the cost effectiveness of QFT versus CXR versus no screening in BCG-vaccinated elderly populations. Methods: We constructed a Markov model to evaluate the cost effectiveness of QFT, CXR, and no screening. The target population was a hypothetical cohort of 1000 immunocompetent 65-year-olds, using a societal perspective and a lifetime horizon. All costs and clinical benefits were discounted at a fixed annual rate of 3%. Results: In the base-case analysis, a no-screening strategy resulted in the lowest cost ($US303.51; 14.6475 quality-adjusted life-years [QALYs]) compared with CXR ($US393.22; 14.6477 QALYs) and QFT ($US525.45; 14.6516 QALYs) [year 2008 values]. The sensitivity of QFT, as well as the prevalence of TB and LTBI, influenced the cost effectiveness; when the sensitivity of QFT was higher than 0.89, QFT became more cost effective than providing no screening. As the prevalence of LTBI and TB increased, the QFT strategy became progressively more cost effective. Conclusions: Providing no routine TB screening is currently the most cost-effective strategy for BCGvaccinated elderly populations in Japan. There appears to be little role for CXR in TB screening of elderly populations. These findings may be applicable to other countries with intermediate and high TB risks when choosing optimal TB screening of elderly populations.
Introduction Tuberculosis (TB) is a globally widespread infectious disease, which inflicts great damage in communities around the world. Japan, where TB is endemic, is considered to have an intermediate risk. In 2008, the prevalence of newly diagnosed TB was 24 760 cases, with an incidence of 19.4/100 000 people. Well over half of the cases were in those aged over 65 years. Among those TB cases
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