Testing for and treating latent tuberculosis infection (LTBI) is among the main strategies to achieve TB elimination in the United States. This analysis estimated health outcomes, costs, and cost-effectiveness of LTBI testing and treatment among non-US born residents with and without medical comorbidities (e.g., diabetes, HIV infection, and end-stage renal disease).
A decision analytic tree and Markov cohort simulation model was used to compare the following strategies: no testing, tuberculin skin test (TST), interferon gamma release assay (IGRA), confirm positive (initial TST, IGRA only for TST-positive results; both tests positive indicates LTBI), and confirm negative (initial IGRA, then TST for IGRA-negative; any test positive indicates LTBI). The analysis used a health care sector perspective with 3% annual discounting.
Testing for and treating LTBI among non-US born residents with and without selected comorbidities is likely cost-effective except among those with ESRD in whom competing risks of death limit benefits. Strategies including IGRA fell below a $100 000/QALY willingness-to-pay threshold for non-US born patients with no comorbidities, patients with diabetes, and patients with HIV.
See associated editorial here.
Tasillo A, Salomon JA, Trikalinos TA et al. Cost-Effectiveness of Testing and Treatment for Latent Tuberculosis Infection in Residents Born Outside the United States With and Without Medical Comorbidities in a Simulation Model. JAMA Internal Medicine 2017. http://jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2017.3941