CXR at port of arrival | Screening for LTBI | Cases of active TB (over 20 years) | Costs (£, 2010) | Incremental cases of active TB | Incremental costs (£, 2010) | ICER | |
---|---|---|---|---|---|---|---|
Screening tool | Screening threshold for immigrants (cases of TB/100 000 per year) | ||||||
No | None | None | 100.5 | 659 609.4 | Baseline | Baseline | Baseline |
No | TST plus QFN | 350 | 100.4 | 690 521.6 | Extended dominance | Extended dominance | Extended dominance |
No | TST plus T-SPOT.TB | 350 | 100.3 | 696 433.4 | Extended dominance | Extended dominance | Extended dominance |
No | TST | 350 | 100.1 | 706 478.7 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus QFN | 300 | 100.0 | 707 756.2 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus T-SPOT.TB | 300 | 99.8 | 715 317.0 | Strict dominance | Strict dominance | Strict dominance |
No | QFN | 350 | 99.4 | 701 675.9 | Extended dominance | Extended dominance | Extended dominance |
No | TST | 300 | 99.4 | 721 759.0 | Extended dominance | Extended dominance | Extended dominance |
No | T-SPOT.TB | 350 | 99.3 | 728 560.7 | Strict dominance | Strict dominance | Strict dominance |
Yes | None | None | 98.9 | 754 339.9 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus QFN | 350 | 98.8 | 785 252.0 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus T-SPOT.TB | 350 | 98.7 | 791 163.9 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST | 350 | 98.5 | 801 209.1 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus QFN | 300 | 98.4 | 802 486.6 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus T-SPOT.TB | 300 | 98.2 | 810 047.5 | Strict dominance | Strict dominance | Strict dominance |
No | QFN | 300 | 98.0 | 723 513.2 | Extended dominance | Extended dominance | Extended dominance |
Yes | QFN | 350 | 97.8 | 796 406.3 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST | 300 | 97.8 | 816 489.4 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus QFN | 250 | 97.8 | 793 192.7 | Strict dominance | Strict dominance | Strict dominance |
No | T-SPOT.TB | 300 | 97.7 | 751 926.8 | Extended dominance | Extended dominance | Extended dominance |
Yes | T-SPOT.TB | 350 | 97.7 | 823 291.1 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus T-SPOT.TB | 250 | 97.3 | 813 690.1 | Extended dominance | Extended dominance | Extended dominance |
Yes | QFN | 300 | 96.4 | 818 243.7 | Extended dominance | Extended dominance | Extended dominance |
Yes | TST plus QFN | 250 | 96.2 | 887 923.2 | Strict dominance | Strict dominance | Strict dominance |
No | TST | 250 | 96.2 | 823 749.7 | Extended dominance | Extended dominance | Extended dominance |
Yes | T-SPOT.TB | 300 | 96.1 | 846 657.3 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus T-SPOT.TB | 250 | 95.7 | 908 420.5 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus QFN | 200 | 95.6 | 867 394.4 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus T-SPOT.TB | 200 | 95.0 | 913 943.4 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST | 250 | 94.6 | 918 480.1 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus QFN | 200 | 94.0 | 962 124.9 | Strict dominance | Strict dominance | Strict dominance |
No | TST | 200 | 93.8 | 995 462.9 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus T-SPOT.TB | 200 | 93.4 | 1 008 673.9 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus QFN | 150 | 93.0 | 954 636.7 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus T-SPOT.TB | 150 | 92.3 | 1 023 409.3 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST | 200 | 92.2 | 1 090 193.4 | Strict dominance | Strict dominance | Strict dominance |
No | QFN | 250 | 92.1 | 839 713.7 | 8.4 | 180 104.3 | 21 565.3 |
No | TST plus QFN | 100 | 91.5 | 1 018 843.7 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus QFN | 150 | 91.4 | 1 049 367.2 | Strict dominance | Strict dominance | Strict dominance |
No | T-SPOT.TB | 250 | 91.3 | 909 426.7 | Extended dominance | Extended dominance | Extended dominance |
No | TST plus T-SPOT.TB | 100 | 90.7 | 1 113 644.2 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus T-SPOT.TB | 150 | 90.7 | 1 118 139.7 | Strict dominance | Strict dominance | Strict dominance |
No | TST | 150 | 90.6 | 1 149 671.8 | Strict dominance | Strict dominance | Strict dominance |
Yes | QFN | 250 | 90.6 | 934 444.2 | Extended dominance | Extended dominance | Extended dominance |
Yes | TST plus QFN | 100 | 89.9 | 1 113 574.1 | Strict dominance | Strict dominance | Strict dominance |
Yes | T-SPOT.TB | 250 | 89.7 | 1 004 157.2 | Strict dominance | Strict dominance | Strict dominance |
No | QFN | 200 | 89.1 | 959 014.5 | Extended dominance | Extended dominance | Extended dominance |
Yes | TST plus T-SPOT.TB | 100 | 89.1 | 1 208 374.6 | Strict dominance | Strict dominance | Strict dominance |
No | TST | 100 | 89.0 | 1 319 841.4 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST | 150 | 89.0 | 1 244 402.3 | Strict dominance | Strict dominance | Strict dominance |
No | T-SPOT.TB | 200 | 88.2 | 1 171 831.5 | Strict dominance | Strict dominance | Strict dominance |
Yes | QFN | 200 | 87.6 | 1 053 744.9 | Extended dominance | Extended dominance | Extended dominance |
Yes | TST | 100 | 87.4 | 1 414 571.9 | Strict dominance | Strict dominance | Strict dominance |
Yes | T-SPOT.TB | 200 | 86.6 | 1 266 562.0 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus QFN | 40 | 86.5 | 1 159 835.9 | Strict dominance | Strict dominance | Strict dominance |
No | TST plus T-SPOT.TB | 40 | 85.5 | 1 296 089.2 | Strict dominance | Strict dominance | Strict dominance |
Yes | TST plus QFN | 40 | 84.9 | 1 254 566.3 | Strict dominance | Strict dominance | Strict dominance |
No | QFN | 150 | 84.3 | 1 089 176.5 | 7.8 | 249 462.8 | 31 867.1 |
Yes | TST plus T-SPOT.TB | 40 | 83.9 | 1 390 819.6 | Strict dominance | Strict dominance | Strict dominance |
No | TST | 40 | 83.3 | 1 597 273.1 | Strict dominance | Strict dominance | Strict dominance |
No | T-SPOT.TB | 150 | 83.0 | 1 408 873.0 | Strict dominance | Strict dominance | Strict dominance |
No | QFN | 100 | 82.8 | 1 195 634.0 | Strict dominance | Strict dominance | Strict dominance |
Yes | QFN | 150 | 82.7 | 1 183 906.9 | Extended dominance | Extended dominance | Extended dominance |
Yes | TST | 40 | 81.7 | 1 692 003.5 | Strict dominance | Strict dominance | Strict dominance |
No | T-SPOT.TB | 100 | 81.5 | 1 666 546.8 | Strict dominance | Strict dominance | Strict dominance |
Yes | T-SPOT.TB | 150 | 81.4 | 1 503 603.4 | Strict dominance | Strict dominance | Strict dominance |
Yes | QFN | 100 | 81.2 | 1 290 364.5 | Extended dominance | Extended dominance | Extended dominance |
Yes | T-SPOT.TB | 100 | 79.9 | 1 761 277.3 | Strict dominance | Strict dominance | Strict dominance |
No | QFN | 40 | 74.9 | 1 414 623.3 | 9.4 | 325 446.8 | 34 753.5 |
Yes | QFN | 40 | 73.4 | 1 509 353.7 | 1.6 | 94 730.4 | 59 489.1 |
No | T-SPOT.TB | 40 | 73.3 | 2 095 182.0 | Extended dominance | Extended dominance | Extended dominance |
Yes | T-SPOT.TB | 40 | 71.7 | 2 189 912.4 | 1.7 | 680 558.7 | 402 421.8 |
*Ranking different strategies from least effective to most effective (ie, number of cases of active TB predicted to occur) results in the ICERs of most screening options being excluded through extended dominance, which is when the ICER for a particular screening threshold is higher than for the next most effective strategy (screening threshold) and so the higher ICER is removed from the cost-effectiveness analysis.
†Current National Institute for Clinical Excellence guidance recommends screening with CXR on arrival, using single-step IGRA or dual TST plus confirmatory IGRA at an incidence threshold of 40/100 000 (bold rows).
CXR, chest x-ray; ICER, incremental cost-effectiveness ratio; IGRA, interferon γ release assay; LTBI, latent tuberculosis infection; QFN, QuantiFERON Gold in-tube; TST, tuberculin skin test.