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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 (tcampo@fjd.es)
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Abstract

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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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