If the increasing evidence that IGRA positive subjects have a higher probability of progression to active TB holds true, the IGRA-only screening strategy should prove to be the more cost-effective test. In this study, sensitivity of the QFT was assumed to be clearly higher than that of the TST (76% vs. 67%) and the drop-out rate for reading of the first TST was high at 12%.

The ultimate aim of LTBI screening is the prevention of progression to active TB via chemoprevention.

[28] analysed the outcomes of INH treatment of close contacts in Switzerland using the Markov model over a 20-year period following screening with the TST-only (three different cut-off values: 5, 10 and 15 mm) and the T-SPOT.TB-only or as a two-step strategy with the TST. They have given final approval of the version to be published.

They compared the QFT-only strategy with the TST followed by the QFT strategy and TST-only strategy. 2007, London, UK.

Both IGRAs were more effective and less costly than the TST. So far, the assumption of a different progression rate in direct comparison of TST-positive and IGRA-positive subjects is based on two publications [8, 9]. different assumptions on the test parameters, especially of specificity for both test systems, where assumptions varied between 34 and 98% even among non-BCG vaccinated for the TST and between 95% and 100% for the IGRAs, it has to be pointed out that the studies considered in that review cannot be directly compared to each other. Eur Respir J. 2006, 28: 45-50. Only in the younger group, and with a TST cut-off of > 15 mm, was the ICER of € 26,451/LY below the willingness-to-pay threshold of US$ 50,000 (or € 40,195; average exchange rate for 2004: US$ = € 0.8039); all other TST-only options were not cost-effective. Whether the introduction of IGRA in the TB screening of contacts is cost-effective (in terms of producing expenditures below a predefined WTP threshold per LYG) in this respect was analysed in eight studies from six different countries (US, Canada, Japan, Switzerland, France, UK and Germany). 10.1016/S0140-6736(00)02742-2.

Studies were included if they used versions of the commercially available IGRAs as a screening test for LTBI and performed any kind of cost or cost-effectiveness analysis based on high-risk populations (HCWs, immigrants and close contacts). The most cost-effective strategy was the two-step strategy with TST and T-SPOT (₤ 37,206), followed very closely by the TST/QFT strategy (₤ 37,699). However, a recent meta-analysis of TST and IGRA sensitivity for active TB indicates that the sensitivity assumed for the TST and IGRA was quite high and that the differences between sensitivity of TST and IGRA might be as large as 14%, well outside of the 1% to 9% range assumed in the papers reviewed here [30]. All studies performed TB screening on groups at high risk for developing tuberculosis: HCWs [25], close contacts [15, 19, 21, 22, 24, 26–28], and immigrants from high-incidence countries [23]. Like its predecessor, QFT-Plus is an interferon gamma release assay, commonly known as an IGRA, and is a modern alternative to the tuberculin skin test … All studies performed TB screening on high risk groups for developing tuberculosis: HCWs [25], close contacts [15, 19, 22, 24, 26–28], or immigrants from high-incidence countries [23]. The present study was designed to evaluate the cost-effectiveness of these strategies in a population in which TST specificity is thought to be lower than the specificity of IGRA.

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