Authors: Burgos, J.L.¹; Kahn, J.G.²; Strathdee, S.A.¹; Valencia-Mendoza, A.³; Bautista-Arredondo, S.³; Laniado-Laborin, R.⁴; Castañeda, R.⁴; Deiss, R.¹; Garfein, R.S.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 8, August 2009 , pp. 962-968(7)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

OBJECTIVE: To assess the cost-effectiveness of screening for latent tuberculosis infection (LTBI) using a commercially available detection test and treating individuals at high risk for human immunodeficiency virus (HIV) infection in a middle-income country.

DESIGN: We developed a Markov model to evaluate the cost per LTBI case detected, TB case averted and quality-adjusted life year (QALY) gained for a cohort of 1000 individuals at high risk for HIV infection over 20 years. Baseline model inputs for LTBI prevalence were obtained from published literature and cross-sectional data from tuberculosis (TB) screening using QuantiFERON®-TB Gold In-Tube (QFT-GIT) testing among sex workers and illicit drug users at high risk for HIV recruited through street outreach in Tijuana, Mexico. Costs are reported in 2007 US dollars. Future costs and QALYs were discounted at 3% per year. Sensitivity analyses were performed to evaluate model robustness.

RESULTS: Over 20 years, we estimate the program would prevent 78 cases of active TB and 55 TB-related deaths. The incremental cost per case of LTBI detected was US$730, cost per active TB averted was US$529 and cost per QALY gained was US$108.

CONCLUSIONS: In settings of endemic TB and escalating HIV incidence, targeting LTBI screening and treatment among high-risk groups may be highly cost-effective.

Keywords: cost-effectiveness; QuantiFERON; latent tuberculosis infection; screening

Document Type: Regular paper

Affiliations: 1: Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, California, USA 2: Philip R. Lee Institute for Health Policy Studies and Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA 3: Dirección de Economía de la Salud, Instituto Nacional de Salud Pública, Cuernavaca, México 4: Facultad de Medicina, Universidad Autónoma de Baja California, Tijuana, México

Publication date: 2009-08-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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