Interferon-gamma release assay for tuberculosis screening of solid-organ transplant recipients is cost-effective - 28/12/18
Highlights |
• | Pre-transplant prevention with LTBI treatment improves recipient outcomes. |
• | We evaluated the cost-effectiveness of interferon-gamma release assays (IGRAs). |
• | Decision trees and Markov models were developed for kidney, liver and lung recipients. |
• | IGRA was more cost-effective than the tuberculin skin test and no screening. |
• | TB screening using IGRA is recommended for solid organ transplantation. |
Summary |
Objectives |
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.
Methods |
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.
Results |
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.
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Latent tuberculosis infection, Transplantation, Economic analysis, Prevention, IGRA, Isoniazid
Abbreviations : LTBI, TB, QALY, ICER, QFT, TSPOT, TST, 9H, BCG
Plan
Vol 78 - N° 1
P. 58-65 - janvier 2019 Retour au numéro
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