Owusu-Edusei K, Stockbridge E L, Winston C A, Kolasa M, Miramontes R
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, Arizona, USA.
Int J Tuberc Lung Dis. 2017 Jun 1;21(6):684-689. doi: 10.5588/ijtld.16.0617. Epub 2017 Mar 28.
To describe tuberculin skin test (TST) and interferon-gamma release assay (IGRA) (i.e., QuantiFERON®-TB [QFT] and T-SPOT®.TB [T-SPOT]) use among privately insured persons in the United States over a 15-year period.
We used current procedural terminology (CPT) codes for the TST and IGRAs to extract out-patient claims (2000-2014) and determined usage (claims/100 000). The χ2 test for trend in proportions was used to describe usage trends for select periods.
The TST was the dominant (>80%) test in each year. Publication of guidelines preceded the assignment of QFT and T-SPOT CPT codes by 1 year (2006 for QFT; 2011 for T-SPOT). QFT usage was higher (P < 0.01) than T-SPOT in each year. The average annual increase in the use of QFT was higher than that of T-SPOT (35 vs. 3.8/100 000), and more so when the analytic period was 2011-2014 (65 vs. 38/100 000). However, during that 4-year period (2011-2014), TST use trended downward, with an average annual decrease of 28/100 000. The annual proportion of enrollees tested ranged from 1.1% to 1.5%.
These results suggest a gradual shift from the use of the TST to the newer IGRAs. Future studies can assess the extent, if any, to which the shift from the use of the TST to IGRAs evolved over time.
描述美国15年间私人保险人群中结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA，即QuantiFERON®-TB [QFT]和T-SPOT®.TB [T-SPOT]）的使用情况。
我们使用TST和IGRAs的现行程序术语（CPT）编码提取门诊索赔数据（2000 - 2014年），并确定使用情况（每10万人中的索赔数）。采用比例趋势的χ2检验来描述特定时期的使用趋势。
每年TST都是主要检测方法（>80%）。指南发布比QFT和T-SPOT的CPT编码分配早1年（QFT为2006年；T-SPOT为2011年）。每年QFT的使用量高于T-SPOT（P < 0.01）。QFT使用量的年均增长高于T-SPOT（分别为35/10万和3.8/10万），在分析期为2011 - 2014年时差异更明显（分别为65/10万和38/10万）。然而，在2011 - 2014年这4年期间，TST的使用呈下降趋势，年均下降28/10万。每年接受检测的参保者比例在1.1%至1.5%之间。
这些结果表明从使用TST逐渐转向使用更新的IGRAs。未来的研究可以评估从使用TST转向IGRAs的转变随着时间推移的程度（如果有的话）。
