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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
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  1. A B Hardy,
  2. R Varma,
  3. T Collyns,
  4. S J Moffitt,
  5. C Mullarkey,
  6. J P Watson
  1. Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr A B Hardy, Leeds Teaching Hospitals NHS Trust, Department of Respiratory Machine, Beckett Street, Leeds LS9 7TF, UK; andrewbhardy{at}yahoo.co.uk

Abstract

NICE (National Institute for Health and Clinical Excellence) 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. A revised screening policy using first-line QuantiFERON-TB Gold (QFT) in high risk immigrants was piloted 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 £9781.82 (£34.94 per immigrant) and identified 105 cases of LTBI. The cost to identify one case of LTBI following NICE guidelines would be £160.81 and using the present protocol was £93.16. For immigrants from high risk countries QFT 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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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.