Cost effectiveness of the interferon-γ release assay for tuberculosis screening of hemodialysis patients.

BACKGROUND

The incidence of tuberculosis and latent tuberculosis infection in hemodialysis patients is higher than that in the general population. Our aim was to assess the cost effectiveness of QuantiFERON(®)-TB Gold In-Tube (QFT) compared with the tuberculin skin test (TST) and the chest x-ray examination (CXR) for tuberculosis screening of hemodialysis patients.

METHODS

Markov models were constructed using a societal perspective on the lifetime horizon. The target population was a hypothetical cohort of 40-year-old hemodialysis patients. All costs and clinical benefits were discounted at a fixed annual rate of 3%. Three strategies QFT, TST and CXR were modeled.

RESULTS

In the base-case analysis, QFT yielded the greatest benefits at the lowest cost [US$7694.43; 4.19 258 quality-adjusted life-years (QALYs)] compared with the TST (US$9337.81; 4.18 543 QALYs) and CXR (US$12 951.36; 4.14 821 QALYs) (year 2012 values). The cost effectiveness was sensitive to the the Bacillus Calmette Guérin (BCG) vaccination rate. The TST strategy was more cost effective than the QFT strategy at the willingness-to-pay level of US$50 000/QALY gained when the rate of BCG vaccination was 0.18 or lower. The cost-effectiveness acceptability curve of 40-year-old patients by Monte Carlo simulations for 10 000 trials demonstrated that the QFT was the most cost effective with a value of 100% at all willingness-to-pay levels compared with TST and CXR.

CONCLUSIONS

The QFT is the most cost-effective method for the tuberculosis screening of hemodialysis patients. Interferon-γ release assays should be recommended in clinical practice on the basis of their cost effectiveness, as well as their higher specificity, compared with TST and CXR.