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

Auguste, Peter; Mistry, Hema; McCarthy, Noel D.; Sutcliffe, Paul; Clarke, Aileen

doi:10.1097/qad.0000000000003060

Cited by 5 publications

(3 citation statements)

References 35 publications

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“…A UK study examined five TBI testing strategies for HIV-infected individual. The QuantiFERON-TB Gold In-Tube negative followed by TST strategy was the most costly and effective (ICER = £20,163/QALY), with a probability of 41% to be cost-effective at thresholds above £40,000 per QALY 49 . Another model-based cost-effectiveness study of testing for TBI also found that confirm sequential negative test (IGRA followed by TST) in non-US-born HIV patients was the preferred cost-effective strategy, with an incremental QALY (0.0008) at incremental cost USD 50 per person and ICER 63,000 USD/QALY (compared to no testing) 48 .…”

Section: Discussionmentioning

confidence: 99%

Cost effectiveness analysis of single and sequential testing strategies for tuberculosis infection in adults living with HIV in the United States

Fekadu

Yao

You

2022

Sci Rep

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Tuberculosis infection (TBI) frequently progresses to tuberculosis (TB) disease in people co-infected with human immunodeficiency virus (HIV). We examined the cost-effectiveness of single, sequential and no testing (total 12) strategies of TBI in HIV-infected people from the perspective of US healthcare provider. A decision-analytic model (20-year timeframe) was constructed to simulate TB-related outcomes: Direct medical cost and quality-adjusted life-years (QALYs). In the base-case analysis, the “confirm negative TST followed by QFT-Plus” strategy gained 0.1170 QALY at a total cost of USD3377. In the probabilistic sensitivity analysis of 10,000 Monte Carlo simulations, the probability of “confirm negative TST followed by QFT-Plus” to be accepted as cost-effective was the highest of all 12 strategies when the willingness-to-pay threshold exceeded 2340 USD/QALY. In conclusion, the strategy of “confirm negative TST followed by QFT-Plus” appears to be the preferred cost-effective option for TBI testing in HIV-infected people from the US healthcare provider’s perspective.

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Section: Discussionmentioning

confidence: 99%

Cost effectiveness analysis of single and sequential testing strategies for tuberculosis infection in adults living with HIV in the United States

Fekadu

Yao

You

2022

Sci Rep

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“…There are different conclusions about the predictive ability of IGRAs due to different follow-up periods, but at least patients with negative IGRAs have a low risk of ATBI in a short time [ 55 , 72 ]. Using it for predicting ATBI was reported to be cost-effective in some countries [ 73 ]. In addition, IGRAs are more convenient (one visit only) and improve screening rates for LTBI [ 74 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Interferon-Gamma Release Assays for Tuberculosis in the Immunocompromised Population

Yang

Wang

et al. 2022

Diagnostics

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Interferon-gamma release assays (IGRAs) are widely used in the diagnosis of Mycobacterium tuberculosis (M. tuberculosis) infection by detecting interferon-γ released by previously sensitized T-cells in-vitro. Currently, there are two assays based on either enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunospot (ELISPOT) technology, with several generations of products available. The diagnostic value of IGRAs in the immunocompromised population is significantly different from that in the immunocompetent population because their results are strongly affected by the host immune function. Both physiological and pathological factors can lead to an immunocompromised situation. We summarized the diagnostic value and clinical recommendations of IGRAs for different immunocompromised populations, including peoplewith physiological factors (pregnant and puerperal women, children, and older people), as well as people with pathological factors (solid organ transplantation recipients, combination with human immunodeficiency virus infection, diabetes mellitus, end-stage renal disease, end-stage liver disease, and chronic immune-mediated inflammatory diseases). Though the performance of IGRAs is not perfect and often requires a combination with other diagnostic strategies, it still has some value in the immunocompromised population. Hopefully, the newly developed IGRAs could better target this population.

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“…Latent TB infection (LTBI) is treatable through TB preventive therapy (TPT) especially when the infection occurred from index cases with drug sensitive TB, but its application has been skewed and mostly restricted to low‐burden settings until recently due to concerns over cost‐effectiveness, reinfection and resistance [6, 7]. Nevertheless, there is growing recognition of advancing the inclusion and expansion in coverage of TPT services as a key priority for TB elimination and achieving global end TB targets by interrupting the chain of TB transmission [6, 8].…”

Section: Introductionmentioning

confidence: 99%

Implementation of tuberculosis preventive therapy with INH‐Rifapentine (3HP) for latent tuberculosis infection management in household tuberculosis contacts in India: A prospective study

Sharma,

Bakshi,

Basu

et al. 2023

Tropical Med Int Health

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ObjectiveThe primary objective of this study was to ascertain the acceptance, initiation, implementation and treatment completion rates of tuberculosis (TB) preventive therapy (TPT) using 3HP (INH‐Rifapentine) among household contacts of microbiologically confirmed drug sensitive TB cases on anti‐tubercular treatment under programmatic real‐world settings. The secondary objectives were to estimate the prevalence and predictors of latent TB infection (LTBI) in household contacts of the index TB cases. We also ascertained the safety profile of the 3HP TPT regimen in the household contacts.MethodsThis prospective observational study was conducted at 10 TB chest clinics in Delhi, India during 2022–2023. Household contacts aged 14 and older who tested positive for TB infection on a Tuberculin Skin test were initiated on the 3HP regimen. Logistic regression was performed by including statistically significant independent variables in multiple prediction models. p < 0.05 was considered statistically significant. STATA, version 15.1, was used to compute all analyses.ResultsA total of 1067 (84.68%) eligible contacts of microbiologically confirmed, drug sensitive TB cases underwent screening with tuberculin skin test (TST), 614 (95.6%) LTBI positive contacts accepted the initiation of TPT, and 564 (91.8%) of those initiated on TPT completed the treatment. The major reason for refusal of screening was the lack of perception of risk of TB disease due to asymptomatic status. The prevalence of LTBI positivity through TST was 61.5% (95% CI, 58.5%, 64.4%). Adverse events were reported by 195 (31.8%) contacts initiated on 3HP of which 20 participants discontinued TPT. None of the sociodemographic factors showed a significant association with LTBI positivity (except age) or TPT completion rates.ConclusionLTBI management with 3HP is feasible among adolescent and adult household contacts in India with high rates of adherence from initiation until treatment completion. The maximum attrition of participants occurred at the time of screening for LTBI using TST.

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

Cited by 5 publications

References 35 publications

Cost effectiveness analysis of single and sequential testing strategies for tuberculosis infection in adults living with HIV in the United States

Cost effectiveness analysis of single and sequential testing strategies for tuberculosis infection in adults living with HIV in the United States

Diagnostic Value of Interferon-Gamma Release Assays for Tuberculosis in the Immunocompromised Population

Implementation of tuberculosis preventive therapy with INH‐Rifapentine (3HP) for latent tuberculosis infection management in household tuberculosis contacts in India: A prospective study

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