Benefits of Screening for Latent Mycobacterium tuberculosis Infection

Rose, David N.

doi:10.1001/archinte.160.10.1513

Cited by 55 publications

(49 citation statements)

References 87 publications

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“…Therefore, the rates of reactivation TB among persons with LTBI observed in this study may be applicable to the population of the United States as a whole. It is important to determine if this is the case, because cost-effectiveness studies using the older rates have indicated that LTBI treatment is generally beneficial in all persons with LTBI (40)(41)(42)(43). A lower rate of reactivation among persons with LTBI would call into question the cost-effectiveness of LTBI treatment among persons with LTBI who do not have risk factors for increased rates of reactivation, such as HIV infection, old healed disease, or exogenous immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Revisiting Rates of Reactivation Tuberculosis

Horsburgh¹,

O’Donnell²,

Chamblee³

et al. 2010

Am J Respir Crit Care Med

131

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Rationale: Reactivation tuberculosis (TB) occurs as a result of reactivation of latent TB infection (LTBI), and was reported to occur in the United States at a rate of 0.10 to 0.16 cases per 100 person-years in the 1950s; it has not been measured since. Objectives: To calculate the rate of reactivation TB in a U.S. community. Methods: A population-based tuberculin skin test survey for LTBI was performed in western Palm Beach County, Florida, from 1998 to 2000 along with a cluster analysis of TB case isolates in the same area from 1997 to 2001. Reactivation (unclustered) TB was presumed to have arisen from the population with LTBI. Measurements and Main Results: The rate of reactivation TB among persons with LTBI without HIV infection was 0.040 cases per 100 person-years (95% confidence interval ½CI, 0.024-0.067) using the n method and 0.058 cases per 100 person-years (95% CI, 0.038-0.089) using the n-1 method. HIV infection was the strongest risk factor for reactivation (rate ratio ½RR, 57; 95% CI, 27-120; P , 0.001). Among persons without HIV infection, reactivation was increased among those older than 50 years (RR, 3.8; 95% CI, 1.3-11) and among those born in the United States (RR, 3.2; 95% CI, 1.1-9.3). Conclusions: Rates of reactivation TB in this area have declined substantially since the 1950s. The greatest part of this decline may be attributed to the disappearance of old, healed TB in the population. If similar declines are seen in other areas of the United States, the cost-effectiveness of screening and treatment of LTBI may be substantially less than previously estimated.

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Section: Discussionmentioning

confidence: 99%

Revisiting Rates of Reactivation Tuberculosis

Horsburgh¹,

O’Donnell²,

Chamblee³

et al. 2010

Am J Respir Crit Care Med

131

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“…Rose 281 provides a Markov model of screening for LTBI with TST within various different patient groups: 3-year-old children exposed to high-risk adults and in a number of groups of 3-year-old adults. Prevalence rates of LTBI within these groups for modelling are as follows:…”

Section: Review Of Cost-effectiveness Literaturementioning

confidence: 99%

“…A relatively simple model of the effectiveness of these testing strategies could be developed, following the lines of Rose 281 in allowing for less than perfect specificities but also allowing for less than perfect sensitivities (Figure 31). …”

Section: Strategy 4 (mentioning

confidence: 99%

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A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

Dinnes¹,

Deeks²,

Kunst³

et al. 2007

Health Technol Assess

538

361

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“…However, these studies were not designed to tailor the LTBI treatment decision to individual patients and thus ignored a range of pertinent factors [6][7][8][9][10][11][12][13]. These factors include the positive and negative predictive value of the tuberculin skin test (TST) or an interferon-γ release assay (IGRA), as well as factors that influence the risk of reactivation of TB and the risk of adverse effects of treatment with isoniazid [14].…”

Section: Introductionmentioning

confidence: 99%

Benefit of treatment of latent tuberculosis infection in individual patients

2015

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We aimed to develop a decision aid that estimates whether treatment of latent tuberculosis infection (LTBI) is likely to have a net gain in quality-adjusted life-years for an individual.A Markov model was developed which incorporated personalised estimates for risk of tuberculosis (TB) reactivation, TB death, quality-of-life impairments and treatment side-effects. The net effect of LTBI treatment was quantified in terms of quality-adjusted life-years gained or lost. Analyses were conducted for a representative set of hypothetical patients.LTBI treatment was estimated to be beneficial when the annual risk of TB reactivation exceeded 13/100 000 to 93/100 000 for females aged 10-75 years and 15/100 000 to 119/100 000 for males aged 10-75 years; the numbers needed to treat to avoid one case of TB were 93, 77, 85 and 72, respectively, at these threshold levels.LTBI treatment was estimated to confer a positive net benefit across a broad range of patients with characteristics typically seen in a low incidence setting for TB. Use of the decision aid has the potential to facilitate and increase confidence with LTBI treatment decisions by providing clinicians and patients with personalised estimates of likely net benefit. @ERSpublications Personalised analysis showed that most people with latent tuberculosis infection benefit from preventive treatment

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Benefits of Screening for Latent Mycobacterium tuberculosis Infection

Cited by 55 publications

References 87 publications

Revisiting Rates of Reactivation Tuberculosis

Revisiting Rates of Reactivation Tuberculosis

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

Benefit of treatment of latent tuberculosis infection in individual patients

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