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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
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 | ||||||
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| Subjects: | Q Science > QR Microbiology > QR355 Virology R Medicine > RA Public aspects of medicine |
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| 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: |
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| 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: |
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