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Cost effectiveness of the NICE guidelines for screening for latent tuberculosis infection: the Quantiferon-TB gold IGRA alone is more cost effective for immigrants from high burden countries
  1. Andrew B Hardy*,
  2. Ramesh Varma,
  3. Timothy Collyns,
  4. Sandy J Moffitt,
  5. Cathy Mullarkey,
  6. John P Watson
  1. 1 Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
  1. Correspondence to: Andrew Hardy, Respiratory Medicine, St James University Hospital, Beckett Street, Leeds, Leeds, LS9 7TF, United Kingdom; andrewbhardy{at}yahoo.co.uk

Abstract

NICE guidelines for new entrant tuberculosis (TB) screening recommend chest X-ray (CXR) for immigrants from countries with TB incidence >40/105, and tuberculin skin test (TST) for people with normal CXR from very high TB prevalence countries. We piloted a revised screening policy using first-line QuantiFERON-TB Gold (QFT) in high risk immigrants in 2007. Initially, TST was offered to immigrants from countries with TB incidence 200-339/105, and QFT to those from countries with incidence >340/105. When increased resources became available, all immigrants from countries with TB incidence >200/105 had QFT. Those with positive QFT were invited for CXR. 1336 immigrant were invited for screening with a 32% attendance rate. 280 patients had QFT of which 38% were positive, with <2% being indeterminate. Using the NICE approach the cost of screening these 280 immigrants would be £13,346.75 (£47.67 per immigrant) and would identify 83 cases of latent TB infection (LTBI). Using first line QFT followed by CXR the cost was £9,781.82 (£34.94 per immigrant) and identified 105 LTBI. The cost to identify one case of LTBI following NICE guidelines would be £160.81 and using our protocol was £93.16. For immigrants from high risk countries QuantiFERON-TB Gold blood testing followed by CXR is feasible for TB screening, cheaper than screening using the NICE guideline and identifies more cases of LTBI

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