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Cost-effectiveness of testing for latent tuberculosis infection in people with HIV

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Auguste, Peter E., Mistry, Hema, McCarthy, Noel D., Sutcliffe, Paul and Clarke, Aileen (2022) Cost-effectiveness of testing for latent tuberculosis infection in people with HIV. AIDS, 36 (1). pp. 1-9. doi:10.1097/QAD.0000000000003060 ISSN 0269-9370.

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Official URL: https://doi.org/10.1097/QAD.0000000000003060

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Abstract

Objective:
The aim of this study was to estimate the cost-effectiveness of screening strategies for predicting LTBI that progresses to active tuberculosis (TB) in people with HIV.

Design:
We developed a decision-analytical model that constituted a decision tree covering diagnosis of LTBI and a Markov model covering progression to active TB. The model represents the lifetime experience following testing for LTBI, and discounting costs, and benefits at 3.5% per annum in line with UK standards. We undertook probabilistic and one-way sensitivity analyses.

Setting:
UK National Health Service and Personal Social Service perspective in a primary care setting.

Participants:
Hypothetical cohort of adults recently diagnosed with HIV.

Interventions:
Interferon-gamma release assays and tuberculin skin test.

Main outcome measure:
Cost per quality-adjusted life year (QALY).

Results:
All strategies except T-SPOT.TB were cost-effective at identifying LTBI, with the QFT-GIT-negative followed by TST5mm strategy being the most costly and effective. Results indicated that there was little preference between strategies at a willingness-to-pay threshold of £20 000. At thresholds above £40 000 per QALY, there was a clear preference for the QFT-GIT-negative followed by TST5mm, with a probability of 0.41 of being cost-effective. Results showed that specificity for QFT-GIT and TST5mm were the main drivers of the economic model.

Conclusion:
Screening for LTBI has important public health and clinical benefits. Most of the strategies are cost-effective. These results should be interpreted with caution because of the paucity of studies included in the meta-analysis of test accuracy studies. Additional high-quality primary studies are needed to have a definitive answer about, which strategy is the most effective.

Item Type: Journal Article
Subjects: Q Science > QR Microbiology > QR355 Virology
R Medicine > RA Public aspects of medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Library of Congress Subject Headings (LCSH): Tuberculosis -- Diagnosis -- Cost effectiveness, Latent Tuberculosis -- Epidemiology, HIV Infections -- Complications, Tuberculin test, HIV-positive persons
Journal or Publication Title: AIDS
Publisher: LIPPINCOTT WILLIAMS & WILKINS
ISSN: 0269-9370
Official Date: 1 January 2022
Dates:
DateEvent
1 January 2022Published
18 August 2021Accepted
Volume: 36
Number: 1
Page Range: pp. 1-9
DOI: 10.1097/QAD.0000000000003060
Status: Peer Reviewed
Publication Status: Published
Reuse Statement (publisher, data, author rights): "This is a non-final version of an article published in final form in Auguste, Peter E.a; Mistry, Hemaa; McCarthy, Noel D.b; Sutcliffe, Paul A.a; Clarke, Aileen E.a Cost-effectiveness of testing for latent tuberculosis infection in people with HIV, AIDS: January 1, 2022 - Volume 36 - Issue 1 - p 1-9 doi: 10.1097/QAD.0000000000003060
Access rights to Published version: Restricted or Subscription Access
Date of first compliant deposit: 26 January 2022
Date of first compliant Open Access: 1 January 2023
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDNational Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West MidlandsUNSPECIFIED

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