Cost-effectiveness analysis of targeted and sequential screening strategies for latent tuberculosis

Int J Tuberc Lung Dis. 2011 Sep;15(9):1223-30, i. doi: 10.5588/ijtld.10.0542.


Setting: No cost-effectiveness studies of testing for latent tuberculosis infection have incorporated both targeted testing and the use of interferon-gamma release assays (IGRAs) in heterogeneous populations.

Objective: To examine the cost-effectiveness of universal vs. targeted and sequential testing strategies and the use of tuberculin skin testing (TST) vs. IGRAs.

Design: Using a decision-analytic model, incremental cost-effectiveness ratios were calculated in 2009 among nine potential strategies for screening recruits. A societal perspective was taken over a 20-year analytic horizon, discounting future costs at 3% annually. Sensitivity analyses were conducted to determine how changes in assumptions affected the estimates.

Results: Targeted strategies cost over US$250 000 per case prevented, whereas universal testing strategies cost over US$700 000 per incremental case prevented in base case and most sensitivity analyses.

Conclusion: Targeted testing offered the best value in this population, although it was still relatively expensive compared to no testing. Sequential testing with both TST and IGRAs provided a poor incremental value compared to targeted and universal testing strategies. Targeted testing using TST was slightly more cost-effective than targeted testing using either QuantiFERON®-TB Gold In-Tube or T-SPOT®.TB, but these estimates were very sensitive to changes in model assumptions.

Publication types

  • Comparative Study

MeSH terms

  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Humans
  • Interferon-gamma Release Tests / economics
  • Interferon-gamma Release Tests / methods*
  • Latent Tuberculosis / diagnosis*
  • Mass Screening / economics
  • Mass Screening / methods*
  • Models, Economic
  • Tuberculin Test / economics
  • Tuberculin Test / methods*