General Affairs Department, Ota City Office, Tokyo, Japan.
J Infect. 2019 Jan;78(1):58-65. doi: 10.1016/j.jinf.2018.07.003. Epub 2018 Jul 24.
Tuberculosis (TB) is a serious infectious disease with high mortality for solid-organ transplantation. Preventive therapy of latent tuberculosis infection (LTBI) has been considered to reduce TB risk and improve outcomes of transplantation. The aim of this study was to evaluate the cost-effectiveness of the interferon-gamma release assays (IGRAs); QuantiFERON-TB Gold in-Tube (QFT) and T-SPOT.TB (TSPOT)), for kidney, liver and lung transplant recipients in low TB incidence countries.
Decision trees and Markov models were developed for four strategies; QFT, TSPOT, the tuberculin skin test (TST) and no screening. Targeted populations were hypothetical cohorts of kidney, liver and lung transplant recipients aged 40 years using a societal perspective on a lifetime horizon. Per-person costs, effectiveness and incremental cost effectiveness ratios were calculated and compared.
QFT was the most cost-effective (Kidney; US$ 5679, 3.026 QALYs, Liver; US$ 5914, 2.365 QALYs, Lung; US$ 6092, 3.761 QALYs). No screening was the least effective. Cost-effectiveness was not sensitive to BCG vaccination rate, and the costs of screening tests and treatment.
TB screening using IGRA with individualized TB risk assessment and follow-up monitoring of drug toxicity during LTBI treatment is recommended for solid organ transplantation, on the basis of the benefits and cost-effectiveness.
结核病（TB）是一种严重的传染病，对实体器官移植患者的死亡率较高。潜伏性结核感染（LTBI）的预防性治疗被认为可以降低 TB 风险并改善移植的结局。本研究旨在评估干扰素 -γ释放试验（IGRAs）；QuantiFERON-TB Gold in-Tube（QFT）和 T-SPOT.TB（TSPOT））在 LTBI 治疗中对低 TB 发病率国家的肾、肝和肺移植受者的成本效益。
为 QFT、TSPOT、结核菌素皮肤试验（TST）和无筛查四种策略建立决策树和马尔可夫模型。目标人群是使用终生社会视角的 40 岁肾、肝和肺移植受者假设队列。计算并比较了每人的成本、效果和增量成本效果比。
QFT 是最具成本效益的（肾；5679 美元，3.026 QALYs；肝；5914 美元，2.365 QALYs；肺；6092 美元，3.761 QALYs）。无筛查效果最差。成本效益对 BCG 疫苗接种率以及筛查试验和治疗成本不敏感。
基于效益和成本效益，建议使用 IGRA 对实体器官移植患者进行 TB 筛查，并对 LTBI 治疗期间的药物毒性进行个体化 TB 风险评估和随访监测。
