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Cost Effectiveness of Interferon-Gamma Release Assay for School-Based Tuberculosis Screening

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Abstract

Purpose

To assess the cost effectiveness of school-based tuberculosis (TB) screening using QuantiFERON®-TB Gold In-Tube (QFT) versus the tuberculin skin test (TST) and chest x-ray examination (CXR).

Methods

We constructed Markov models of first-year high-school and university students, using a societal perspective, and followed them up until the age of 80 years. Three strategies (QFT, TST, and CXR) were modeled. All costs and clinical benefits were discounted at a fixed annual rate of 3%.

Results

In the base-case analyses of 16-year-old high-school students and 19-year-old university students, the QFT strategy yielded the greatest benefits at the lowest cost [in year 2009 values] (16-year-olds: $US627.89, 29.69835 quality-adjusted life-years [QALYs]; 19-year-olds: $US646.04, 29.15361 QALYs), compared with the TST strategy (16-year-olds: $US943.50, 29.69767 QALYs; 19-year-olds: $US998.62, 29.15288 QALYs) and the CXR strategy (16-year-olds: $US7286.24, 29.69532 QALYs; 19-year-olds: $US7305.19, 29.14911 QALYs). On one-way sensitivity analyses, the bacillus Calmette-Guérin (BCG) vaccination rate was not sensitive to the TST strategy. On probabilistic sensitivity analysis, the QFT strategy was the most cost effective, with a willingness-to-pay level of $US50 000/QALY gained.

Conclusion

The QFT strategy provided the greatest benefits at the lowest cost for school-based TB screening. There appears to be little role for TST or CXR in screening of school populations. Current practices using either TST or CXR screening should be reconsidered on the basis of cost effectiveness.

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Acknowledgments

No sources of funding were used to conduct this study or prepare this manuscript. The author has no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Kojiya Haneda Healthcare Service, Ota City Public Health Office, 1-21-15 Higashikojiya, Ota-ku, Tokyo, 144-0033, Japan

    Akiko Kowada

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  1. Akiko Kowada
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Correspondence to Akiko Kowada.

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Kowada, A. Cost Effectiveness of Interferon-Gamma Release Assay for School-Based Tuberculosis Screening. Mol Diagn Ther 16, 181–190 (2012). https://doi.org/10.1007/BF03262207

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