London’s approach to diagnosing latent tuberculosis infection (LTBI) among adult close contacts of active TB cases has undergone a significant evaluation. Recent research highlights the cost-effectiveness of various screening methods, shedding light on the most efficient strategies for public health implementation.
Study Overview and Methodology
Researchers conducted a retrospective analysis of 381 asymptomatic adults aged between 18 and 65 who were close contacts of pulmonary TB patients. These individuals were tested using both the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) between 2008 and 2010. The majority of participants (75.3%) had received the BCG vaccine. The study employed a Markov model from the NHS perspective, considering lifetime costs and quality-adjusted life-years (QALYs).
Key Findings and Cost-Effectiveness
The analysis compared five different LTBI screening strategies: TST alone, QuantiFERON-TB Gold In-Tube (QFT) alone, T-SPOT.TB (T-SPOT) alone, TST followed by QFT, and TST followed by T-SPOT. Results indicated that IGRA-alone strategies, particularly QFT, offered the highest cost-effectiveness at a willingness-to-pay threshold of £25,000. Specifically, QFT demonstrated an incremental net monetary benefit (INMB) of £214 compared to T-SPOT, which had an INMB of £199.
Inferences:
- IGRAs provide a more cost-effective solution compared to traditional TST in high-risk populations.
- QuantiFERON-TB Gold In-Tube slightly outperforms T-SPOT.TB in economic evaluations.
- BCG vaccination status did not significantly affect the cost-effectiveness of IGRA strategies.
The study underscores the advantage of using a single-step IGRA approach over the combined TST and IGRA methods, simplifying the screening process while maintaining economic efficiency.
Adopting QuantiFERON as the primary screening tool could streamline LTBI detection protocols, reduce overall healthcare costs, and improve patient outcomes by enabling timely and accurate diagnosis. Public health policies may benefit from integrating these findings to enhance TB control measures in urban settings.
Implementing QuantiFERON-TB Gold In-Tube as the frontline screening method provides a pragmatic balance between cost and efficacy. This shift not only optimizes resource allocation within the NHS but also aligns with best practices for managing latent TB in populations with high BCG vaccination rates. As London continues to tackle TB, evidence-based strategies like this will be crucial in driving forward public health initiatives and ensuring the well-being of its residents.
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