Cost-Effectiveness Analysis Comparing QuantiFERON-TB Gold Plus Test and Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Immunocompetent Subjects in Colombia

• Published in: Value in health regional issues Vol. 41; pp. 54 - 62
• Main Authors: Navarro, Cristian E., Betancur, John E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2024
• Subjects: Adult; Colombia - epidemiology; Cost-Benefit Analysis - methods; Cost-Effectiveness Analysis; Humans; Immunocompetence; incremental cost-effectiveness ratio; interferon-gamma release tests; Interferon-gamma Release Tests - economics; Interferon-gamma Release Tests - methods; Interferon-gamma Release Tests - standards; latent tuberculosis; Latent Tuberculosis - diagnosis; Latent Tuberculosis - economics; Latent Tuberculosis - epidemiology; quantiferon; Sensitivity and Specificity; tuberculin test; Tuberculin Test - economics; Tuberculin Test - methods; Colombia; incremental cost-effectiveness ratio; tuberculin test; quantiferon; cost-effectiveness analysis; latent tuberculosis; interferon-gamma release tests
• ISSN: 2212-1099; 2212-1102; 2212-1102
• DOI: 10.1016/j.vhri.2023.11.010

To determine the cost-effectiveness of the QuantiFERON-TB Gold Plus (QFT-Plus) test versus the tuberculin skin test in diagnosing latent tuberculosis infection in immunocompetent subjects in the context of the Colombian healthcare system. A hypothetical cohort of 2000 immunocompetent adults vaccinated with Bacillus Calmette-Guérin at birth who are asymptomatic for tuberculosis disease was simulated and included in a decision tree over a horizon of <1 year. The direct healthcare costs related to tests, antituberculosis treatment, and medical care were considered, and diagnostic performance was used as a measure of effectiveness. The incremental cost-effectiveness ratio (ICER) was estimated, and univariate deterministic and probabilistic sensitivity analyses were carried out using 5000 simulations. The currency was the US dollar for the year 2022, with a cost-effectiveness threshold of $6666 USD (1 gross domestic product per capita for 2022). QFT-Plus was cost-effective with an ICER of $5687 USD for each correctly diagnosed case relative to a threshold of $6666 USD. In the deterministic analysis, QFT-Plus was cost-effective in half of the proposed scenarios. The variable that most affected the ICER was the prevalence of latent tuberculosis and test sensitivities. In the probabilistic analysis, QFT-Plus was cost-effective in 54.74% of the simulated scenarios, and tuberculin skin test was dominant in 13.84%. The study provides evidence of the cost-effectiveness of QFT-Plus compared with the tuberculin skin test in diagnosing latent tuberculosis infection in immunocompetent adults in the Colombian context. •QuantiFERON-TB Gold Plus and tuberculin skin test are useful in the diagnosis of latent tuberculosis infection in the absence of a gold standard. They have similar diagnostic performance according to some meta-analysis. However, they have not been evaluated in a head-to-head cost-effectiveness study in the Colombian context.•To our knowledge, this is the first study evaluating the cost-effectiveness of QuantiFERON-TB Gold Plus and tuberculin skin test in immunocompetent subjects before starting immunosuppressive therapy from the third payer’s perspective in Colombia. In the base case scenario, QuantiFERON-TB Gold Plus has proven to be a cost-effective test. The above was proven in different proposed scenarios in the deterministic and probabilistic sensitivity analyses.•In the base case scenario, tuberculin skin test increased the false-negative results by 105%. Tuberculin skin test was the dominant strategy in 2 situations, when the latent tuberculosis infection prevalence and the QuantiFERON-TB Gold Plus sensitivity were at the lowest values.