Molecular Diagnosis & Therapy

, Volume 12, Issue 4, pp 235–251 | Cite as

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

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.

Notes

Acknowledgments

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

The authors wish to thank Dr Joshua Levi Jacobs, MD, for his editorial help.

References

  1. 1.
    World Health Organization. Global tuberculosis control: surveilance, planning, financing. WHO Report 2007; WHO/HTM/TB/2007.376 [online]. Available from URL: http://www.who.int/tb/publications/global_report/2007/en/ [Accessed 2008 Apr 22]
  2. 2.
    Health Labour and Welfare Ministry. Epidemiology of tuberculosis in Japan [in Japanese]. Tokyo: Health Labour and Welfare Ministry, 2007Google Scholar
  3. 3.
    Macintyre CR, Plant AJ, Hendrie D. The cost-effectiveness of evidence-based guidelines and practice for screening and prevention of tuberculosis. Health Econ 2000; 9(5): 411–21PubMedCrossRefGoogle Scholar
  4. 4.
    Diel R, Nienhaus A, Lange C, et al. Cost-optimisation of screening for latent tuberculosis in close contacts. Eur Respir J 2006; 28(1): 35–44PubMedCrossRefGoogle Scholar
  5. 5.
    Mori T, Harada N. Cost-effectiveness analysis of QuantiFERON-TB 2nd generation used for detection of tuberculosis infection in contact investigations [in Japanese]. Kekkaku 2005; 80(11): 675–86PubMedGoogle Scholar
  6. 6.
    The National Tuberculosis Controllers Association and CDC. Guidelines for the investigation of contacts of persons with infectious tuberculosis: recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Recomm Rep 2005 Dec 16; 54 (RR-15): 1-47 [online]. Available from URL: http://www.cdc.gov/mmwr/pdf/rr/rr5415.pdf [Accessed 2008 Apr 22]
  7. 7.
    Kowada A, Hamada Y, Aoki M. Utility of QuantiFERON TB-2G for tuberculosis contact investigations in public health services [in Japanese]. Nippon Koshu Eisei Zasshi 2007; 54(7): 434–9PubMedGoogle Scholar
  8. 8.
    Diel R, Zaslavsky AM, Loddenkemper R. Cost-effectiveness of interferon-gamma release assay screening for latent tuberculosis infection treatment in Germany. Chest 2007; 131(5): 1424–34PubMedCrossRefGoogle Scholar
  9. 9.
    Diel R, Wrighton-Smith P, Zellweger JP. Cost-effectiveness of interferon-gamma release assay testing for the treatment of latent tuberculosis. Eur Respir J 2007 Aug; 30(2): 321–32PubMedCrossRefGoogle Scholar
  10. 10.
    Mazurek GH, Jereb J, Lobue P, et al. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 2005; 54(RR-15): 49–55PubMedGoogle Scholar
  11. 11.
    Health Labour and Welfare Ministry. Guidelines for the investigation of contacts of persons with infectious tuberculosis. Tokyo: Health Labour and Welfare Ministry, 2007 [in Japanese; online]. Available from URL: http://www.phcd.jp/shiryo/TB/2007TBsesshokusha_kenshin_tebiki_2han.pdf [Accessed 2008 May 21]
  12. 12.
    Health Labour and Welfare Ministry. Guidelines for preventing the transmission of mycobacterium tuberculosis in health-care settings [in Japanese]. Tokyo: Health Labour and Welfare Ministry, 1999Google Scholar
  13. 13.
    Life table in Japan, 2005 [in Japanese; online]. Available from URL: http://www.mhlw.go.jp/toukei/saikin/hw/life/20th/index.html [Accessed 2008 May 21]
  14. 14.
    Research Institute of Tuberculosis in Japan. Research project for surveillance [in Japanese]. Tokyo: Research Institute of Tuberculosis in Japan, 2006Google Scholar
  15. 15.
    Jereb J, Etkind SC, Joglar OT, et al. Tuberculosis contact investigations: outcomes in selected areas of the United States, 1999. Int J Tuberc Lung Dis 2003; 7(12 Suppl. 3): S384–90PubMedGoogle Scholar
  16. 16.
    Tokyo Metropolitan Government. Tuberculosis in Tokyo [in Japanese]. Tokyo: Health and Safety Office Bureau of Welfare and Public Health, 2005Google Scholar
  17. 17.
    Aziz MA, Wright A, Laszlo A, et al. Epidemiology of antituberculosis drug resistance (the Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis. Lancet 2006; 368(9553): 2142–54PubMedCrossRefGoogle Scholar
  18. 18.
    Tuberculosis Research Committee (Ryoken). Drug-resistant Mycobacterium tuberculosis in Japan: a nationwide survey, 2002. Int J Tuberc Lung Dis 2007 Oct; 11(10): 1129–35Google Scholar
  19. 19.
    Horsburgh Jr CR. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 2004; 350(20): 2060–7PubMedCrossRefGoogle Scholar
  20. 20.
    Kimura M, Comstock GW, Mori T. Comparison of erythema and induration as results of tuberculin tests. Int J Tuberc Lung Dis 2005; 9(8): 853–7PubMedGoogle Scholar
  21. 21.
    Yoshiyama T. Cost effectiveness analysis of isoniazid preventive therapy to the contacts of tuberculosis patients under Japanese settings [in Japanese]. Kekkaku 2000; 75(11): 629–41PubMedGoogle Scholar
  22. 22.
    Yoshiyama T, Ogata H, Wada M. Treatment results of multi drug resistant tuberculosis, a hospital based study [in Japanese]. Kekkaku 2005; 80(11): 687–93PubMedGoogle Scholar
  23. 23.
    Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 2007; 146(5): 340–54PubMedGoogle Scholar
  24. 24.
    Mori T, Sakatani M, Yamagishi F, et al. Specific detection of tuberculosis infection: an interferon-gamma-based assay using new antigens. Am J Respir Crit Care Med 2004; 170(1): 59–64PubMedCrossRefGoogle Scholar
  25. 25.
    Ito K, Hoshino H, Nakazono T, et al. Liver damage in treatment of latent tuberculous infection by isoniazid [in Japanese]. Kekkaku 2006; 81(11): 651–60PubMedGoogle Scholar
  26. 26.
    Fountain FF, Tolley E, Chrisman CR, et al. Isoniazid hepatotoxicity associated with treatment of latent tuberculosis infection: a 7-year evaluation from a public health tuberculosis clinic. Chest 2005; 128(1): 116–23PubMedCrossRefGoogle Scholar
  27. 27.
    LoBue PA, Moser KS. Use of isoniazid for latent tuberculosis infection in a public health clinic. Am J Respir Crit Care Med 2003; 168(4): 443–7PubMedCrossRefGoogle Scholar
  28. 28.
    Miyashita H, Higuchi K, Higashiyama N, et al. Detection of tuberculosis infection using a whole blood interferon gamma assay in a contact investigation: evaluation using quantiFERon TB-2G [in Japanese]. Kekkaku 2005; 80(8): 557–64PubMedGoogle Scholar
  29. 29.
    Diel R, Nienhaus A, Schaberg T. Cost-effectiveness of isoniazid chemoprevention in close contacts. Eur Respir J 2005; 26(3): 465–73PubMedCrossRefGoogle Scholar
  30. 30.
    Moran-Mendoza O, Marion SA, Elwood K, et al. Tuberculin skin test size and risk of tuberculosis development: a large population-based study in contacts. Int J Tuberc Lung Dis 2007; 11(9): 1014–20PubMedGoogle Scholar
  31. 31.
    Farhat M, Greenaway C, Pai M, et al. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis 2006; 10(11): 1192–204PubMedGoogle Scholar
  32. 32.
    Igakutsushin-sha. Medical insurance reimbursement table in Japan [in Japanese]. Tokyo: Igakutsushin-sha, 2007 [online]. Available from URL: http://igakutushin.co.jp/index1.php?contenturl=page1.php?sid=299 [Accessed 2008 May 21]
  33. 33.
    Kang YA, Choi YJ, Cho YJ, et al. Cost of treatment for multidrug-resistant tuberculosis in South Korea. Respirology 2006; 11(6): 793–8PubMedCrossRefGoogle Scholar
  34. 34.
    Health Labour and Welfare Ministry. Basic survey on wage structure in Japan [in Japanese]. Tokyo: Health, Labour and Welfare Ministry, 2006Google Scholar
  35. 35.
    Statistics Bureau. Japan statistical yearbook 2007 [in Japanese]. Tokyo: Ministry of Internal Affairs and Communications, 2007Google Scholar
  36. 36.
    Organisation for Economic Co-operation and Development. Purchasing power parities data. Organisation for Economic Co-operation and Development, 2007 [in Japanese; online]. Available from URL: http://www.oecd.org/dataoecd/61/56/39653523.xls [Accessed 2008 Apr 22]
  37. 37.
    Weinstein MC, Siegel JE, Gold MR, et al. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996; 276(15): 1253–8PubMedCrossRefGoogle Scholar
  38. 38.
    Arend SM, Thijsen SF, Leyten EM, et al. Comparison of two interferon-gamma assays and tuberculin skin test for tracing tuberculosis contacts. Am J Respir Crit Care Med 2007; 175(6): 618–27PubMedCrossRefGoogle Scholar
  39. 39.
    Funayama K, Tsujimoto A, Mori M, et al. Usefulness of QuantiFERON TB-2G in contact investigation of a tuberculosis outbreak in a university [in Japanese]. Kekkaku 2005; 80(7): 527–34PubMedGoogle Scholar
  40. 40.
    Health Labour and Welfare Ministry. Interferon-gamma release assay as tuberculosis screening test in Japan [in Japanese; online]. Available from URL: http://www.toyama.med.or.jp/kaiin/tuti/kensaryou.pdf [Accessed 2008 May 21]
  41. 41.
    Research Institute of Tuberculosis in Japan. Tuberculosis reaction surveillance [in Japanese]. Tokyo: Research Institute of Tuberculosis in Japan, 1999Google Scholar
  42. 42.
    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(1): 16–26PubMedGoogle Scholar
  43. 43.
    TB guidelines [in Japanese; online]. Available from URL: http://www.cdc.gov/TB/pubs/mmwr/Maj_guide/cdc_ats_guidelines.htm [Accessed 2008 Apr 23]

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

Personalised recommendations