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Free Content Cost-effectiveness of tobacco cessation support combined with tuberculosis screening among contacts who smoke

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SETTING: Tobacco smoking is associated with significantly increased risks of latent tuberculous infection, active tuberculosis (TB), TB recurrence and mortality. Tobacco cessation interventions not only increase health benefits, they also reduce the risk of TB.

OBJECTIVE: To assess the cost-effectiveness of nicotine replacement therapy (NRT) combined with TB screening strategies using interferon-gamma release assays (IGRAs; QuantiFERON®-TB Gold In-Tube [QFT] and T-SPOT®.TB [T-SPOT]) and comparing these with the tuberculin skin test (TST) among TB contacts who smoke.

DESIGN: Decision trees and Markov models were constructed from a public health perspective. The target population was a hypothetical cohort of 20-year-old contacts who smoke until the age of 70 years, with or without NRT. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio was compared.

RESULTS: QFT alone led to lower costs but fewer QALYs. TST alone and TST+NRT were absolutely dominated. IGRAs+NRT yielded greater benefits than IGRAs alone, and T-SPOT+NRT yielded the greatest benefits. Cost-effectiveness was sensitive to NRT effectiveness and rate of mortality reduction using NRT.

CONCLUSION: TB screening using an IGRA combined with NRT is more cost-effective among contacts who smoke. Positive smoking cessation interventions are recommended for their cost-effectiveness in low-incidence countries.
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Keywords: TB control; chemoprophylaxis; interferon-gamma release assay; nicotine replacement therapy; public health

Document Type: Research Article

Affiliations: Health Management Division, General Affairs Department, Ota City Office, Tokyo, Japan

Publication date: July 1, 2015

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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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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