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Cost-Effectiveness of Different Screening Strategies (Single or Dual) for the Diagnosis of Tuberculosis Infection in Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

M. Teresa del Campo ,
Hadia Fouad ,
M. Marcela Solís-Bravo ,
M. Angeles Sánchez-Uriz ,
Ignacio Mahíllo-Fernández  and
Jaime Esteban
M. Teresa del Campo*
Affiliation:
Department of Occupational Health and Prevention, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
Hadia Fouad
Affiliation:
Department of Occupational Health and Prevention, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
M. Marcela Solís-Bravo
Affiliation:
Department of Occupational Health and Prevention, Infanta Leonor University Hospital, Universidad Complutense de Madrid, Madrid, Spain
M. Angeles Sánchez-Uriz
Affiliation:
Department of Occupational Health and Prevention, Infanta Leonor University Hospital, Universidad Complutense de Madrid, Madrid, Spain
Ignacio Mahíllo-Fernández
Affiliation:
Division of Epidemiology, Department of Clinical Research, Fundación Jimenez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
Jaime Esteban
Affiliation:
Department of Microbiology, Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
*
Department of Occupational Health and Prevention, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, 2, 28040 Madrid, España ([email protected])
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Abstract

Objective.

To evaluate the cost-effectiveness of a dual strategy of tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT-G) for screening of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) and, as a secondary objective, to study relationships between TST results, QFT-G results, and sociodemographic factors.

Design.

Cross-sectional prospective study.

Setting.

University hospital in Madrid.

Participants.

A total of 103 HCWs.

Methods.

QFT-G was requested for all positive TST results; QFT-G results were compared with TST results, and their relationships with sociodemographic factors were analyzed. A cost-effectiveness analysis was conducted for the dual strategy (TST/QFT-G) and for TST or QFT alone, taking into account the indication of and compliance with isoniazid, the risk of hepatotoxicity, and postexposure tuberculosis.

Results.

Of all HCWs studied, 42.3% showed a positive result by QFT-G, and 49.5% had received bacille Calmette-Guérin (BCG) vaccination; no significant association was detected between BCG and QFT-G results. Increased TST was linked to higher positive QFT-G values (TST of 5–9.9 mm, 27.6%; TST of 15 mm or more, 56.5%; P = .03). The probability of positive QFT-G results was 1.04 times higher for each year of age (odds ratio, 1.04 [95% confidence interval, 1.01–1.09]; P = .0257). The incremental cost per active TB case prevented was lower for TST/QFT-G than for the other strategies studied (€14,211 per 1,000 HCWs). The number of people treated for LTBI per case of active TB prevented (number needed to treat) for TST/QFT-G was lower than for TST alone (17.2 vs 95.3 and 88.7 with the 5- and 10-mm cutoff value, respectively) or QFT-G alone (69.6).

Conclusions.

Dual strategy with TST/QFT-G is more cost-effective than TST or QFT-G alone for the diagnosis of LTBI in HCWs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 12 , December 2012 , pp. 1226 - 1234
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54(RR-17):1–141.Google Scholar
2.Salpeter, SR, Salpeter, EE. Screening and treatment of latent tuberculosis among healthcare workers at low, moderate, and high risk for tuberculosis exposure: a cost-effectiveness analysis. Infect Control Hosp Epidemiol 2004;25:1056–1061.Google Scholar
3. Cellestis. Clinical Experience with QuantiFERON®-TB Gold (In-Tube). http://www.cellestis.com/IRM/Company/ShowPage.aspx?CPID=1254. Published November 2001. Accessed December 3, 2011.Google Scholar
4.Girardi, E, Angeletti, C, Puro, V, et al.Estimating diagnostic accuracy of tests for latent tuberculosis infection without a gold standard among healthcare workers. Euro Surveill 2009;29:14–43.Google Scholar
5.Mazurek, GH, Jereb, J, Vernon, A, et al.Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection—United States, 2010. MMWR Recomm Rep 2010;59(RR-5):1–25.Google Scholar
6. National Institute for Health and Clinical Excellence. Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. http://www.nice.org.uk/nicemedia/live/13422/53642/53642.pdf. Published March 2011. Accessed January 9, 2012.Google Scholar
7.González, J, García, JM, Anibarro, L, et al.Documento de consenso sobre diagnóstico, tratamiento y prevención de la tuberculosis. Enferm Infecc Microbiol Clin 2010;28:297.e1–297.e20.Google Scholar
8.Moreno, S, Blázquez, R, Novoa, A, et al.The effect of BCG vaccination on tuberculin reactivity and the booster effect among hospital employees. Arch Intern Med 2001;161:1760–1765.Google Scholar
9.Shams, H, Weis, SE, Klucar, P, et al.Enzyme-linked immunospot and tuberculin skin testing to detect latent tuberculosis infection. Am J Respir Crit Care Med 2005;172:1161–1168.Google Scholar
10.Diel, R, Nienhaus, A, Lange, C, et al.Cost-optimisation of screening for latent tuberculosis in close contacts. Eur Respir J 2006;28:35–44.Google Scholar
11.Ravn, P, Munk, ME, Andersen, AB, et al.Prospective evaluation of a whole blood test using Mycobacterium tuberculosis–specific antigens ESAT-6 and CEP-10 for diagnosis of active tuberculosis. Clin Diagn Lab Immunol 2005;12:491–496.Google Scholar
12.Goletti, D, Vincenti, D, Carrara, S, et al.Selected RD1 peptides for active tuberculosis diagnosis: comparison of a gamma interferon whole-blood enzyme-linked immunosorben assay and an enzyme-linked immunospot assay. Clin Diagn Lab Immunol 2005;12:1311–1316.Google Scholar
13.Ferrara, G, Losi, M, Damico, R, et al.Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study. Lancet 2006;367:1328–1334.Google Scholar
14.Huebner, RE, Schein, MF, Bass, JB. The tuberculin skin test. Clin Infect Dis 1993;17:968–975.Google Scholar
15.Diel, R, Nienhaus, A, Loddenkemper, R. Cost-effectiveness of interferon-γ release assay screening for latent tuberculosis infection treatment in Germany. Chest 2007;131:1424–1434.Google Scholar
16.Schwartzman, K, Menzies, D. Tuberculosis screening of immigrants to low-prevalence countries: a cost-effectiveness analysis. Am J Respir Crit Care Med 2000;161:780–789.Google Scholar
17.Lee, JY, Choi, HJ, Park, IN, et al.Comparison of two commercial interferon-gamma assays for diagnosing Mycobacterium tuberculosis infection. Eur Respir J 2006;28:24–30.Google Scholar
18.Lobue, PA, Catanzaro, A. Effectiveness of a nosocomial tuberculosis control program at an urban teaching hospital. Chest 1998;113:1184–1189.Google Scholar
19.Taylor, Z. The cost-effectiveness of screening for latent tuberculosis infection. Int J Tuberc Lung Dis 2000;4(suppl 2):S127–S133.Google Scholar
20.Smieja, MJ, Marchetti, CA, Cook, DJ, et al.Isoniazid for preventing tuberculosis in non-HIV infected persons. Cochrane Database Syst Rev 2000;(2):CD001363.Google Scholar
21.Linertová, R, Alvarez-León, EE, García-Pérez, L, et al.Costs of QuantiFERON-TB Gold versus tuberculin skin test in Spanish healthcare workers. J Hosp Infect 2010;75:52–55.Google Scholar
22.Miller, TL, Mcnabb, SJ, Hilsenrath, P, et al.The societal cost of tuberculosis: Tarrant County, Texas, 2002. Ann Epidemiol 2010;20:1–7.Google Scholar
23.Pai, M, Gokhale, K, Joshi, R, et al.Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole blood interferon γ release assay with tuberculin skin testing. JAMA 2005;293:2746–2755.Google Scholar
24.Mirtskulava, V, Kempker, R, Shields, K, et al.Prevalence and risk factors for latent tuberculosis infection among health care workers in Georgia. Int J Tuberc Lung Dis 2008;12:513–519.Google Scholar
25.Harada, N, Nakajima, Y, Higuchi, K, et al.Screening for tuberculosis infection using whole-blood interferon-γ and Mantoux testing among Japanese healthcare workers. Infect Control Hosp Epidemiol 2006;27:442–448.Google Scholar
26.Ciaschetti, A, Franchi, A, Richeldi, L, et al.Screening of latent tuberculosis infection in healthcare workers by Quantiferon TBG and tuberculin skin test. G Ital Med Lav Ergon 2007;29:406–407.Google Scholar
27.Menzies, D, Joshi, R, Pai, M. Risk of tuberculosis infection and disease associated with work in healthcare setting. Int J Tuberc Lung Dis 2007;11:593–605.Google Scholar
28.Eum, SY, Lee, YJ, Kwak, HK, et al.Evaluation of the diagnostic utility of a whole-blood interferon-γ assay for determining the risk of exposure to Mycobacterium tuberculosis in Bacille Calmette-Guerin (BCG)–vaccinated individuals. Diagn Microbiol Infect Dis 2008;61:181–186.Google Scholar
29.Sherman, HA, Karakis, I, Heimer, D, et al.Housekeeping health care workers have the highest risk for tuberculin skin test conversion. Int J Tuberc Lung Dis 2011;15:1050–1055.Google Scholar
30.Pooran, A, Booth, H, Miller, RF, et al.Different screening strategies (single or dual) for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis. BMC Pulm Med 2010;10:7.Google Scholar
31.Oxlade, O, Schwartzman, K, Menzies, D. Interferon-gamma release assays and TB screening in high-income countries: a cost-effectiveness analysis. Int J Tuberc Lung Dis 2007;11:16–26.Google Scholar
32. Servicio de Epidemiología, Servicio Madrileño de Salud de la Comunidad de Madrid. Registro Regional de Casos de Tuberculosis en la Comunidad de Madrid: Informe del Año 2009. http://www.madrid.org/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobheadername1=Content-disposition&blobheadername2=cadena&blobheadervalue1=filename%3DInforme+Regional+TB+2009.pdf&blobheadervalue2=language%3Des%26site%3DPortalSalud&blobkey=id&blobtable=MungoBlobs&blobwhere=1272102879448&ssbinary=true. Accessed January 9, 2012.Google Scholar
33.De Perio, MA, Tsevat, J, Roselle, GA, et al.Cost-effectiveness of interferon gamma release assays vs tuberculin skin tests in healthcare workers. Arch Intern Med 2009;169:179–187.Google Scholar
34.Fox, BD, Kramer, MR, Mor, Z, et al.The Quantiferon-TB-Gold assay for tuberculosis screening in healthcare workers: a cost-comparison analysis. Lung 2009;187:413–419.Google Scholar
35.Nienhaus, A, Schablon, A, Torres Costa, J, et al.Systematic review of cost and cost-effectiveness of different TB-screening strategies. BMC Health Serv Res 2011;11(247):1–28.Google Scholar
36.Haagsma, JA, Tariq, L, Heederik, DJ, et al.Infectious disease risks associated with occupational exposure: a systematic review of the literature. Occup Environ Med 2012;69:140–146.Google Scholar