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