Molecular Diagnosis & Therapy

, Volume 12, Issue 4, pp 235–251

Cost Effectiveness of Interferon-γ Release Assay for Tuberculosis Contact Screening in Japan

  • Akiko Kowada
  • Osamu Takahashi
  • Takuro Shimbo
  • Sachiko Ohde
  • Yasuharu Tokuda
  • Tsuguya Fukui
Original Research Article

DOI: 10.1007/BF03256289

Cite this article as:
Kowada, A., Takahashi, O., Shimbo, T. et al. Mol Diag Ther (2008) 12: 235. doi:10.1007/BF03256289

Abstract

Background: Nearly the entire population of Japan has been vaccinated with Bacillus Calmette-Guerin (BCG), which causes a false-positive result in the tuberculin skin test (TST). The interferon-γ release assay QuantiFERON®-TB Gold (QFT) is a new alternative to the TST that can be used to screen for latent tuberculosis infection and active tuberculosis, as it has no cross-reactivity with BCG.

Methods: We constructed a Markov model to evaluate the cost effectiveness of the QFT for tuberculosis contact screening. The target population is a hypothetical cohort of 1000 immunocompetent 20-year-old individuals who have had contact with sputum-smear-positive pulmonary tuberculosis patients. The analysis was conducted from a societal perspective over the lifetime of a contact. We compared the QFT-alone strategy with the TST followed by QFT (TST/QFT) strategy and the TST-alone strategy.

Results: In a base-case analysis, the QFT-alone strategy was dominant ($US471.54; 28.1099 quality-adjusted life-years [QALYs]), compared with the TST/QFT strategy ($US500.55; 28.1087 QALYs) and the TST-alone strategy ($US573.98; 28.1079 QALYs). The incremental cost-effectiveness ratio of the QFT-alone strategy was a cost saving of $US23 043.5/QALY gained compared with the TST/QFT strategy. On one-way sensitivity analysis, TST specificity and the prevalence of tuberculosis/latent tuberculosis infection affected the cost effectiveness. The probabilistic analysis showed that the QFT-alone strategy has a 95% chance of being cost effective at a threshold ratio of $US2.10/QALY gained, compared with the TST/QFT strategy.

Conclusion: The QFT-alone strategy is the most cost effective for tuberculosis contact screening in Japan.

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Akiko Kowada
    • 1
  • Osamu Takahashi
    • 2
  • Takuro Shimbo
    • 3
  • Sachiko Ohde
    • 4
  • Yasuharu Tokuda
    • 2
  • Tsuguya Fukui
    • 2
  1. 1.Katsushika City Public Health CenterTokyoJapan
  2. 2.Department of General Internal MedicineSt Luke’s International HospitalTokyoJapan
  3. 3.St Luke’s Life Science InstituteTokyoJapan
  4. 4.Department of Clinical Research and Informatics, International Clinical Research Center, Research InstituteInternational Medical Center of JapanTokyoJapan