Abstract
The goal of this study was to perform a cost-effectiveness analysis from the public health system perspective, comparing five strategies for Latent Tuberculosis Infection (LTBI) diagnosis in primary health care workers in Brazil. Analytical model for decision making, characterized by cost-effectiveness analysis. Primary Care Level, considering primary health care workers in Brazil. An analytical model for decision making, characterized by a tree of probabilities of events, was developed considering a hypothetical cohort of 10,000 primary health care workers, using the software TreeAge Pro™ 2013 to simulate the clinical and economic impacts of new diagnostic technology (QuantiFERON®-TB Gold in-Tube) versus the traditional tuberculin skin test. This model simulated five diagnostic strategies for LTBI in primary health care workers (HCW) in Brazil: tuberculin skin testing using ≥5 mm cut-off, tuberculin skin testing ≥10 mm cut-off, QuantiFERON®-TB Gold in-Tube, tuberculin skin testing using ≥5 mm cut-off confirmed by QuantiFERON®-TB Gold In-Tube if TST positive, tuberculin skin testing using ≥10 mm cut-off confirmed by QuantiFERON®-TB Gold In-Tube if TST positive. The outcome measures are the number of individuals correctly classified by the test and the number of Tuberculosis cases avoided. The most cost-effective strategy was the tuberculin skin test considering ≥10mm cut-off. The isolated use of the QuantiFERON®-TB Gold In-Tube revealed the strategy of lower efficiency with incremental cost-effectiveness ratio (ICER) of US$ 146.05 for each HCW correctly classified by the test. The tuberculin skin test using ≥10 mm cut-off was the most cost-effective strategy in the diagnosis of Latent Tuberculosis Infection in primary health care works in Brazil.
Highlights
Health Care Workers (HCWs) are one of the most vulnerable groups to infection by Mycobacterium tuberculosis (Mtb) [1]
The funders had no role in study design, data analysis, decision to publish, or preparation of the manuscript. This model simulated five diagnostic strategies for Latent Tuberculosis Infection (LTBI) in primary health care workers (HCW) in Brazil: tuberculin skin testing using 5 mm cut-off, tuberculin skin testing 10 mm cut-off, QuantiFERON®-TB Gold in-Tube, tuberculin skin testing using 5 mm cut-off confirmed by QuantiFERON®-TB Gold In-Tube if TST positive, tuberculin skin testing using 10 mm cut-off confirmed by QuantiFERON®-TB Gold In-Tube if TST positive
The isolated use of the QuantiFERON®-TB Gold In-Tube revealed the strategy of lower efficiency with incremental cost-effectiveness ratio (ICER) of US$ 146.05 for each HCW correctly classified by the test
Summary
Health Care Workers (HCWs) are one of the most vulnerable groups to infection by Mycobacterium tuberculosis (Mtb) [1]. According to estimates from the World Health Organization (WHO), 10.0 million people (range, 9.0–11.1 million) developed TB disease in 2017 and 1.6 million death due to TB occurred[5].Despite the decline in the incidence and mortality rates of the disease, one-third of the world population has Latent Tuberculosis Infection (LTBI)[6]. This situation may have improved, as up-to-date estimates indicate that about a quarter of the world’s population is infected, corresponding to 1.7 billion people[7]. To achieve the United Nations Sustainable Development Goal of eliminating this endemic disease by 2050 is necessary to diagnose and to treat the disease with new approaches
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