A cost-effectiveness evaluation of latent tuberculosis infection screening of a migrant population in Malaysia

Abstract

To estimate the costs and benefits of screening for latent tuberculosis infection (LTBI) in a migrant population in Malaysia. An economic model was developed from a Malaysian healthcare perspective to compare QuantiFERON-TB Gold Plus (QuantiFERON) with the tuberculin skin test (TST). A decision tree was used to capture outcomes relating to LTBI screening followed by a Markov model that simulated the lifetime costs and benefits of the patient cohort. The Markov model did not capture the impact of secondary infections. The model included an R shiny interactive interface to allow adaptation to other scenarios and settings. QuantiFERON is both more effective and less costly than TST (dominant). Compared with QuantiFERON, the lifetime risk of developing active TB increases by approximately 40% for TST due to missed LTBI cases during screening (i.e. a higher number of false negative cases for TST). For a migrant population in Malaysia, QuantiFERON is cost-effective when compared with TST. Further research should consider targeted LTBI screening for migrants in Malaysia based on common risk factors.

Screening of household contacts for TB infection in Cote d'Ivoire

“…Overall, our analysis confirmed previous findings that while the unit cost of TST is cheaper than that of QFT, a poorer performance of TST incurs additional expenses that ultimately translate into a more expensive solution. 16 , 26 Recent advancements, such as the approval of novel antigen-based skin tests such as Diaskintest (Generium, Moscow, Russian Federation), C-Tb (Serum Institute of India, Pune, India) and C-TST (Anhui Zhifei Longcom, Anhui, China) by the WHO, aim to address some of the limitations associated with TST. 27 However, these tests, although offering a promising alternative to TST, come with their own set of challenges.…”

“…The economic model, based on R v0.2 (R Computing, Vienna, Austria) with an interactive Shiny interface, has previously been described by Barker et al and customised to compare the effectiveness of QuantiFERON-TB Gold Plus (QuantiFERON) with TST from a healthcare perspective. 16 The model comprised active TB screening conducted prior to TBI screening, wherein patient screening was accomplished using either QuantiFERON or TST. Positive results led to TBI treatment and potential non-adherence.…”

Whole blood vs serum-derived exosomes for host and pathogen-specific tuberculosis biomarker identification: RNA-seq based machine learning approach

“…The existing TB diagnostic tests are focused on detecting Mtb or speci c host immune responses using relatively faster, simpler and cost-effective methods, such as tuberculin skin test (TST), interferon-gamma release assays (IGRAs) (Loureiro et al 2019; Barker et al 2023) or nucleic acid ampli cation tests (NAATs), most commonly the polymerase chain reaction (PCR)-based tests (Chin et al 2018;Nandlal et al 2022). However, these routine diagnostic tests are not speci c for predicting disease progression (Pai and Sotgiu 2016) or distinguishing active disease from the latent infection (Carranza et al 2020).…”

A costing framework to compare tuberculosis infection tests

“…To our knowledge, most costing studies comparing TB diagnostics ignore the opportunity cost—the cost of opportunity forgone, or the potential benefit that would have been incurred should the alternative been chosen—in their calculations, particularly in high-burden, low-income settings 17. For example, cost analyses of TB diagnostics measure patients’ lost income due to diagnosis but do not incorporate benefit to society in the form of reduced transmission 18 19. If new tests improve a diagnostic algorithm’s accuracy, treatment is also more quickly available to a patient, and further disease transmission is averted.…”