QuantiFERON-TB gold in-tube implementation for latent tuberculosis diagnosis in a public health clinic: A cost-effectiveness analysis

Maunank Shah, Kathryn Miele, Howard Choi, Danielle DiPietro, Maria Martins-Evora, Vincent Marsiglia, Susan Dorman

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: The tuberculin skin test (TST) has limitations for latent tuberculosis infection (LTBI) diagnosis in low-prevalence settings. Previously, all TST-positive individuals referred from the community to Baltimore City Health Department (BCHD) were offered LTBI treatment, after active TB was excluded. In 2010, BCHD introduced adjunctive QuantiFERON-TB Gold In-Tube (QFT-GIT) testing for TST-positive referrals. We evaluated costs and cost-effectiveness of this new diagnostic algorithm.Methods: A decision-analysis model compared the strategy of treating all TST-positive referrals versus only those with positive results on adjunctive QFT-GIT testing. Costs were collected at BCHD, and Incremental Cost-Effectiveness Ratios (ICERs) were utilized to report on cost-effectiveness.Results: QFT-GIT testing at BCHD cost Gietz D.*St43.51 per test. Implementation of QFT-GIT testing was associated with an ICER of Gietz D.*St1,202 per quality-adjusted life-year gained and was considered highly cost-effective. In sensitivity analysis, the QFT-GIT strategy became cost-saving if QFT-GIT sensitivity increased above 92% or if less than 3.5% of individuals with LTBI progress to active TB disease.Conclusions: LTBI screening with TST in low-prevalence settings may lead to overtreatment and increased expenditures. In this public health clinic, additional QFT-GIT testing of individuals referred for a positive TST was cost-effective.

Original languageEnglish (US)
Article number360
JournalBMC infectious diseases
StatePublished - Dec 19 2012


  • Diagnosis
  • Implementation
  • Interferon-gamma release assay
  • Latent tuberculosis
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases


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