*Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York; †Department of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts; and ‡Mailman School of Public Health, Columbia University, New York, New York.
Inflamm Bowel Dis. 2013 Oct;19(11):2444-9. doi: 10.1097/MIB.0b013e31829f008f.
Anti-tumor necrosis factor α drugs are known to reactivate latent tuberculosis (TB). Current guidelines recommend screening for latent tuberculosis infection, with either tuberculin skin test (TST) or interferon gamma release assays such as QuantiFERON-TB Gold (QFT-G). Given the high rates of anergy to TST among immunosuppressed inflammatory bowel disease (IBD) patients, there is considerable interest in evaluating the superiority of interferon gamma release assays over TST in this patient population to diagnose latent tuberculosis infection. We compared the performance of TST and QFT-G for screening latent TB among immunosuppressed IBD patients based on prevalence, mortality risk from reactivation TB, and costs.
A decision analytical model was constructed to compare 1-year outcomes and costs of using TST or interferon gamma release assay in an immunosuppressed IBD population.
Under the base case scenario, for every 1000 patients screened, the QFT-G strategy resulted in 0.53 deaths from reactivation TB compared with 1.92 deaths using TST. The QFT-G strategy results in 1.85 reactivation TB versus 6.7 reactivation TB using TST. The model was not sensitive to background prevalence of latent TB. The cost of QFT-G would have to be more than double for the TST strategy to become more cost effective. QFT-G also remains the cost-effective option unless the sensitivity of the TST improves by 400%.
Under a broad range of parameter values, the QFT-G strategy dominates the TST strategy in cost-effectiveness. Consideration should be given to QFT-G as the preferred method of identifying latent TB in all immunosuppressed IBD patients.
已知抗肿瘤坏死因子 α 药物可使潜伏性结核（TB）复发。目前的指南建议对潜伏性结核感染进行筛查，包括结核菌素皮肤试验（TST）或干扰素γ释放试验，如 QuantiFERON-TB Gold（QFT-G）。鉴于免疫抑制性炎症性肠病（IBD）患者对 TST 存在较高的无反应率，因此人们非常关注在这种患者人群中评估干扰素γ释放试验优于 TST 来诊断潜伏性结核感染的优越性。我们比较了 TST 和 QFT-G 在免疫抑制性 IBD 患者中筛查潜伏性 TB 的性能，基于患病率、结核复发的死亡率风险和成本。
构建了一个决策分析模型，以比较 TST 或干扰素γ释放试验在免疫抑制性 IBD 人群中的 1 年结果和成本。
在基本情况下，在每 1000 名筛查患者中，与 TST 相比，QFT-G 策略导致 0.53 例结核复发死亡。QFT-G 策略导致 1.85 例结核复发，而 TST 则导致 6.7 例结核复发。模型对潜伏性 TB 的背景患病率不敏感。QFT-G 的成本必须超过 TST 策略的两倍以上，才能使 TST 策略更具成本效益。除非 TST 的敏感性提高 400%，否则 QFT-G 仍然是具有成本效益的选择。
在广泛的参数值范围内，QFT-G 策略在成本效益方面优于 TST 策略。应考虑在所有免疫抑制性 IBD 患者中使用 QFT-G 作为识别潜伏性 TB 的首选方法。
