Dados do Trabalho

Título

TB antigen-based skin tests and QFT-Plus® for the diagnosis of Mycobacterium tuberculosis infection in Brazilian healthcare workers: a cost-effectiveness analysis

Introdução

The Brazilian National TB Program (NTP) has defined healthcare workers (HCW) as a priority population for scaling up tuberculosis preventive treatment (TPT) in its 2021-2025 Plan to End TB. Intermittent shortage of PPD Rt-23 and the low specificity of the test in BCG-vaccinated populations have encouraged the NTP to search for newer, more specific tests.

Objetivo(s)

We evaluated the cost-effectiveness of two TB antigen-based skin tests (TBST) and QuantiFERON-TB-Gold-Plus (QFT-Plus®, Qiagen, Germany) versus tuberculin skin test (PPD-TST) in Brazilian HCWs.

Material e Métodos

We developed a cohort-based Markov model to estimate the incremental cost-effectiveness ratio of two TBST [Diaskintest® (Generium, Russian Federation, cost per test: US$ 3.59) and C-TST® (Anhui Zhifei Longcom, China, cost per test: US$ 7.79)] and QFT-Plus® (cost per test: US$ 20.27 ) versus PPD-TST (standard-of-care, cost per test: US$ 2.96) for the annual evaluation of 100.000 HCWs for TBI under the Brazilian health system perspective, over a 5-year time horizon. If TBI was detected, treatment with 3HP (US$ 50.78) was recommended, as per national guidelines. Effectiveness was the number of TB cases averted. Costing data was sourced from previous studies and the NTP (2021 US$). Costs and effectiveness were discounted at a 5% fixed annual rate. We performed probabilistic and deterministic sensitivity analyses. Global Drug Facility (GDF) costs by combined weekly dose of 3HP were used in the sensitivity analysis (US$ 46.44).

Resultados e Conclusão

Diaskintest® strategy was cost-saving for TBI diagnosis (US$ 20.672 per averted TB case). Despite the strategy using the QFT-Plus® having slightly higher effectiveness, it had an incremental cost-effectiveness ratio of US$ 58.384 per TB case averted, mostly driven by equipment and human labor costs. In sensitivity analyses, the Diaskintest® remained cost-saving compared to PPD-TST. In the Brazilian scenario, Diaskintest® is the least costly and most effective test for sequential testing of HCWs, mainly due to the higher costs of QFT-Plus® and lower specificity of PPD-TST.

Palavras-chave

Healthcare Worker; Cost-Effectiveness Analysis; Latent Tuberculosis.

Área

Eixo 13 | Tuberculose e outras micobactérias