Green Nathan, Manalan Kavina, Hayama Manabu, O'Donoghue Marie, Seneviratne Suranjith, Drey Nicholas, Kon Onn Min
Department of Statistical Science, University College London, London, UK.
Tuberculosis Service, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
ERJ Open Res. 2025 Jun 23;11(3). doi: 10.1183/23120541.00818-2024. eCollection 2025 May.
The 2016 National Institute for Health and Care Excellence guidelines recommended the tuberculin skin test (TST), at a 5-mm induration size cut-off, for the diagnosis of latent tuberculosis infection (LTBI) among adult close contacts of active tuberculosis (TB) cases. This study analysed a well-characterised cohort of adult close contacts in London and assessed the cost-effectiveness of LTBI screening strategies with combinations of TST and interferon-γ release assays (IGRAs) in a decision-analytic model.
Close contacts of pulmonary TB cases who were tested with TST and IGRA between January 2008 and December 2010 were retrospectively reviewed. Using an NHS perspective and lifetime horizon, a decision-analytic Markov model was used to compare costs and quality-adjusted life-years (QALYs) associated with five screening strategies followed by LTBI treatment: 1) TST alone; 2) QuantiFERON-TB Gold In-Tube (QFT) alone; 3) T-SPOT.TB (T-SPOT) alone; 4) TST positive followed by QFT; 5) TST positive followed by T-SPOT.
This study included 381 asymptomatic close contacts aged 18 to 65 years (mean±sd 35.2±11.3). 75.3% had received BCG vaccination. Among the five strategies, for a willingness-to-pay threshold of GBP 25 000 and using incremental net monetary benefit (INMB) with TST as comparator, the IGRA-alone strategies were the most cost-effective, marginally QFT over T-SPOT (QFT: GBP 214; T-SPOT: GBP 199).
Single-step IGRA, particularly QuantiFERON, is preferable for LTBI screening of adult close contacts of pulmonary TB cases.
2016年英国国家卫生与临床优化研究所指南推荐,对于活动性肺结核(TB)病例的成年密切接触者,采用硬结大小截断值为5 mm的结核菌素皮肤试验(TST)来诊断潜伏性结核感染(LTBI)。本研究分析了伦敦一组特征明确的成年密切接触者队列,并在决策分析模型中评估了TST与干扰素-γ释放试验(IGRAs)联合使用的LTBI筛查策略的成本效益。
对2008年1月至2010年12月期间接受TST和IGRA检测的肺结核病例密切接触者进行回顾性研究。从英国国家医疗服务体系(NHS)的角度和终身视角出发,使用决策分析马尔可夫模型比较了与五种筛查策略及后续LTBI治疗相关的成本和质量调整生命年(QALYs):1)仅TST;2)仅结核感染T细胞检测(QFT);3)仅T-SPOT.TB(T-SPOT);4)TST阳性后进行QFT;5)TST阳性后进行T-SPOT。
本研究纳入了381名年龄在18至65岁之间的无症状密切接触者(平均±标准差 35.2±11.3)。75.3%的人接种过卡介苗。在这五种策略中,对于支付意愿阈值为25000英镑,并以TST作为对照使用增量净货币效益(INMB)的情况,仅使用IGRA的策略最具成本效益,QFT略优于T-SPOT(QFT:214英镑;T-SPOT:199英镑)。
单步IGRA,尤其是结核感染T细胞检测,对于肺结核病例成年密切接触者的LTBI筛查更为可取。