University Medical Center Hamburg-Eppendorf, Institute for Health Service Research in Dermatology and Nursing - Hamburg, Germany.
BMC Health Serv Res. 2011 Sep 30;11:247. doi: 10.1186/1472-6963-11-247.
Interferon-γ release assays (IGRAs) for TB have the potential to replace the tuberculin skin test (TST) in screening for latent tuberculosis infection (LTBI). The higher per-test cost of IGRAs may be compensated for by lower post-screening costs (medical attention, chest x-rays and chemoprevention), given the higher specificity of the new tests as compared to that of the conventional TST. We conducted a systematic review of all publications that have addressed the cost or cost-effectiveness of IGRAs. The objective of this report was to undertake a structured review and critical appraisal of the methods used for the model-based cost-effectiveness analysis of TB screening programmes.
Using Medline and Embase, 75 publications that contained the terms "IGRA", "tuberculosis" and "cost" were identified. Of these, 13 were original studies on the costs or cost-effectiveness of IGRAs.
The 13 relevant studies come from five low-to-medium TB-incidence countries. Five studies took only the costs of screening into consideration, while eight studies analysed the cost-effectiveness of different screening strategies. Screening was performed in high-risk groups: close contacts, immigrants from high-incidence countries and healthcare workers. Two studies used the T-SPOT.TB as an IGRA and the other studies used the QuantiFERON-TB Gold and/or Gold In-Tube test. All 13 studies observed a decrease in costs when the IGRAs were used. Six studies compared the use of an IGRA as a test to confirm a positive TST (TST/IGRA strategy) to the use of an IGRA-only strategy. In four of these studies, the two-step strategy and in two the IGRA-only strategy was more cost-effective. Assumptions about TST specificity and progression risk after a positive test had the greatest influence on determining which IGRA strategy was more cost-effective.
The available studies on cost-effectiveness provide strong evidence in support of the use of IGRAs in screening risk groups such as HCWs, immigrants from high-incidence countries and close contacts. So far, only two studies provide evidence that the IGRA-only screening strategy is more cost-effective.
干扰素-γ释放检测（IGRAs）在结核分枝杆菌潜伏感染（LTBI）筛查方面具有替代结核菌素皮肤试验（TST）的潜力。与传统 TST 相比，新检测的特异性更高，因此 IGRAs 的单次检测成本较高，但后续筛查成本（医疗关注、胸部 X 光和化学预防）可能会降低。我们对所有涉及 IGRAs 成本或成本效益的出版物进行了系统回顾。本报告的目的是对基于模型的结核筛查计划成本效益分析中使用的方法进行系统回顾和批判性评估。
使用 Medline 和 Embase，确定了包含“IGRA”、“结核”和“成本”术语的 75 篇出版物。其中，13 篇是关于 IGRAs 成本或成本效益的原始研究。
这 13 项相关研究来自五个中低结核发病率国家。五项研究仅考虑了筛查成本，八项研究分析了不同筛查策略的成本效益。筛查在高危人群中进行：密切接触者、来自高发病率国家的移民和卫生保健工作者。两项研究使用 T-SPOT.TB 作为 IGRA，其他研究使用 QuantiFERON-TB Gold 和/或 Gold In-Tube 检测。所有 13 项研究都观察到使用 IGRAs 可降低成本。六项研究将使用 IGRAs 作为测试来确认阳性 TST（TST/IGRA 策略）与仅使用 IGRAs 策略进行比较。在其中四项研究中，两步策略和两项研究中仅 IGRAs 策略更具成本效益。关于 TST 特异性和阳性检测后进展风险的假设对确定哪种 IGRAs 策略更具成本效益有最大影响。
目前关于成本效益的研究提供了强有力的证据支持在高危人群（如 HCW、来自高发病率国家的移民和密切接触者）中使用 IGRAs 进行筛查。到目前为止，只有两项研究提供了证据表明仅 IGRAs 筛查策略更具成本效益。
