Cost-effectiveness of IGRA testing for the treatment of latent tuberculosis in Switzerland

¹ School of Public Health, University of Düsseldorf, Germany
² Oxford Immunotec, Oxford, UK
³ University Medical Policlinic, Lausanne, Switzerland

^* To whom correspondence should be addressed. E-mail: Roland.Diel{at}uni-duesseldorf.de.

	Abstract

To assess the cost-effectiveness of the new T-SPOT^®.TB assay versus the Tuberculin Skin Test (TST) for screening contacts for latent tuberculosis (LTBI) in Switzerland.

Health and economic outcomes of isoniazid (INH) treatment of 20- and 40-year-old close contacts were compared in a Markov model over a 20-year period following screening with TST only (at three cut-off values), T-SPOT.TB alone or in combination with the TST.

T-SPOT.TB based treatment was cost-effective at 11,621 per life-year-gained (LYG) in the younger and 23,692/LYG in the higher age group. No TST-based programs were cost-effective, except at a 15mm-cut-off in the younger group only where the cost-effectiveness (26,451/LYG) just fell below the willingness-to-pay threshold. Combination of the TST with T-SPOT.TB slightly reduced the total cost compared with the T-SPOT.TB alone by 4.4% and 5.0% in the younger and older groups respectively. The number of contacts treated to avoid one case of tuberculosis decreased from 50 [95%CI 32-106] with the TST (10 mm cutoff) to 18 [95%CI 11-43] if T-SPOT.TB was used.

Using T-SPOT.TB alone or in combination with the TST for screening of close contacts before LTBI treatment is highly cost-effective in reducing the disease burden of TB.

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