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Int J Tuberc Lung Dis ; 18(4): 413-20, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24670695

ABSTRACT

BACKGROUND: Interferon-gamma release assays (IGRAs) are reported to be more specific for the diagnosis of latent tuberculous infection (LTBI) than the tuberculin skin test (TST). The two-step procedure, TST followed by an IGRA, is reported to be cost-effective in high-income countries, but it requires more financial resources. OBJECTIVE: To assess the added value of IGRA compared to TST alone in the Netherlands. METHODS: Test results and background data on persons tested with an IGRA were recorded by the Public Municipal Health Services in a web-based database. The number of persons diagnosed with LTBI using different screening algorithms was calculated. RESULTS: In those tested with an IGRA, at least 60% of persons who would have been diagnosed with LTBI based on TST alone had a negative IGRA. Among those with a TST reaction below the cut-off for the diagnosis of LTBI, 13% had a positive IGRA. For 41% of persons tested with an IGRA after TST, the IGRA influenced whether or not an LTBI diagnosis would be made. CONCLUSION: With the IGRA as reference standard, a high proportion of persons in low-prevalence settings are treated unnecessarily for LTBI if tested with TST alone, while a small proportion eligible for preventive treatment are missed. Incremental costs of the two-step strategy seem to be balanced by the improved targeting of preventive treatment.


Subject(s)
Interferon-gamma Release Tests , Latent Tuberculosis/diagnosis , Mycobacterium tuberculosis/pathogenicity , Tuberculin Test , Adolescent , Adult , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Cost-Benefit Analysis , False Negative Reactions , False Positive Reactions , Female , Health Care Costs , Humans , Interferon-gamma Release Tests/economics , Latent Tuberculosis/drug therapy , Latent Tuberculosis/economics , Latent Tuberculosis/immunology , Latent Tuberculosis/microbiology , Male , Middle Aged , Mycobacterium tuberculosis/immunology , Netherlands , Predictive Value of Tests , Reproducibility of Results , Tuberculin Test/economics , Unnecessary Procedures , Young Adult
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