Added value of interferon-gamma release assays in screening for tuberculous infection in the Netherlands

Int J Tuberc Lung Dis. 2014 Apr;18(4):413-20. doi: 10.5588/ijtld.13.0589.


Background: Interferon-gamma release assays (IGRAs) are reported to be more specific for the diagnosis of latent tuberculous infection (LTBI) than the tuberculin skin test (TST). The two-step procedure, TST followed by an IGRA, is reported to be cost-effective in high-income countries, but it requires more financial resources.

Objective: To assess the added value of IGRA compared to TST alone in the Netherlands.

Methods: Test results and background data on persons tested with an IGRA were recorded by the Public Municipal Health Services in a web-based database. The number of persons diagnosed with LTBI using different screening algorithms was calculated.

Results: In those tested with an IGRA, at least 60% of persons who would have been diagnosed with LTBI based on TST alone had a negative IGRA. Among those with a TST reaction below the cut-off for the diagnosis of LTBI, 13% had a positive IGRA. For 41% of persons tested with an IGRA after TST, the IGRA influenced whether or not an LTBI diagnosis would be made.

Conclusion: With the IGRA as reference standard, a high proportion of persons in low-prevalence settings are treated unnecessarily for LTBI if tested with TST alone, while a small proportion eligible for preventive treatment are missed. Incremental costs of the two-step strategy seem to be balanced by the improved targeting of preventive treatment.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antitubercular Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Health Care Costs
  • Humans
  • Interferon-gamma Release Tests* / economics
  • Latent Tuberculosis / diagnosis*
  • Latent Tuberculosis / drug therapy
  • Latent Tuberculosis / economics
  • Latent Tuberculosis / immunology
  • Latent Tuberculosis / microbiology
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / immunology
  • Mycobacterium tuberculosis / pathogenicity*
  • Netherlands
  • Predictive Value of Tests
  • Reproducibility of Results
  • Tuberculin Test* / economics
  • Unnecessary Procedures
  • Young Adult


  • Antitubercular Agents