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

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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.

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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.

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Authors and Affiliations

  1. Katsushika City Public Health Center, 8-18-6 Tateishi, Katsushika-ku, Tokyo, 124-0012, Japan

    Akiko Kowada

  2. Department of General Internal Medicine, St Luke’s International Hospital, Tokyo, Japan

    Osamu Takahashi, Yasuharu Tokuda & Tsuguya Fukui

  3. St Luke’s Life Science Institute, Tokyo, Japan

    Takuro Shimbo

  4. Department of Clinical Research and Informatics, International Clinical Research Center, Research Institute, International Medical Center of Japan, Tokyo, Japan

    Sachiko Ohde

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  1. Akiko Kowada
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  2. Osamu Takahashi
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Correspondence to Akiko Kowada.

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Kowada, A., Takahashi, O., Shimbo, T. et al. Cost Effectiveness of Interferon-γ Release Assay for Tuberculosis Contact Screening in Japan. Mol Diag Ther 12, 235–251 (2008). https://doi.org/10.1007/BF03256289

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