PMID- 29478790
OWN - NLM
STAT- MEDLINE
DCOM- 20180418
LR  - 20180418
IS  - 2213-0276 (Electronic)
IS  - 0755-4982 (Linking)
VI  - 47
IP  - 2
DP  - 2018 Feb
TI  - Cost-effectiveness analysis of strategies using new immunological diagnostic 
      tests of latent tuberculosis infection before TNF-blockers therapy.
PG  - e9-e13
LID - S0755-4982(18)30014-9 [pii]
LID - 10.1016/j.lpm.2017.09.029 [doi]
AB  - Several tests have been proposed to detect latent tuberculosis (LTB). OBJECTIVE: 
      To evaluate the cost-effectiveness of different interferon-gamma release assays 
      based strategies used to screen LTB before tumour necrosis factor (TNF) blockers 
      initiation. METHODS: Consecutive patients with rheumatoid arthritis, 
      spondyloarthritis or Crohn's disease for whom TNF-blockers were considered, were 
      recruited in 15 tertiary care centres. All were screened for LTB with tuberculin 
      skin test (TST), QuantiFERON TB Gold((R)) in tube (QFT) and T-SPOT.TB((R)) (TSpot) on 
      the same day. Cost-minimization and cost-effectiveness analysis, testing 8 
      screening test combinations, were conducted. Effectiveness was defined as the 
      percentage of LTB treatment avoided and compared with TST alone. Cost were 
      elicited in the payer perspective, included all the costs related to the 
      screening procedure. RESULTS: No tuberculosis reactivation was observed after 
      TNF-blocker initiation. TST followed by QFT if TST was positive was found as the 
      best screening strategy, i.e. the less costly (-54euro compared to reference) and 
      most effective (effectiveness 0.93), resulting in an incremental 
      cost-effectiveness ratio of -192euro per treatment avoided. A probabilistic 
      sensitivity analysis confirmed this result in 72.3% of simulations. CONCLUSION: 
      TST followed by QFT if TST was positive is the most cost-effective strategy in 
      screening for LTB in patients before starting anti-TNF therapy. TRIALREGNO: 
      NCT00811343.
CI  - Copyright (c) 2018 Elsevier Masson SAS. All rights reserved.
FAU - Freund, Romain
AU  - Freund R
AD  - Pierre et Marie Curie university-Paris 6, Sorbonne universites, GRC-08 (EEMOIS), 
      75013 Paris, France.
FAU - Granger, Benjamin
AU  - Granger B
AD  - Pierre et Marie Curie university-Paris 6, Sorbonne universites, GRC-08 (EEMOIS), 
      75013 Paris, France; AP-HP, Pitie-Salpetriere hospital, department of 
      biostatistics, public health and medical information (BIOSPIM), 75013 Paris, 
      France.
FAU - Francois, Cecile
AU  - Francois C
AD  - AP-HP, Pitie-Salpetriere hospital, department of biostatistics, public health and 
      medical information (BIOSPIM), 75013 Paris, France.
FAU - Carcelain, Guislaine
AU  - Carcelain G
AD  - Sorbonne universites, UPMC universite Paris 06, Inserm, centre d'immunologie et 
      des maladies infectieuses (CIMI-Paris), UMR 1135, ERL CNRS 8255, 91, boulevard de 
      l'hopital, 75013 Paris, France; Assistance Publique-Hopitaux de Paris, 
      departement d'immunologie, CHU Pitie-Salpetriere, 47-83, boulevard de l'hopital, 
      75013 Paris, France.
FAU - Ravaud, Philippe
AU  - Ravaud P
AD  - AP-HP, epidemiology center, Hotel-Dieu, 75004 Paris, France; Rene Descartes 
      university, inserm, UMR 1153, Hotel-Dieu, 75181 Paris cedex, France.
FAU - Mariette, Xavier
AU  - Mariette X
AD  - AP-HP, Bicetre hospital, universite Paris-Sud, department of rheumatology, 94270 
      Le Kremlin Bicetre, France; CRI-IMIDIATE clinical research network, 75013, Paris, 
      France.
FAU - Fautrel, Bruno
AU  - Fautrel B
AD  - Pierre et Marie Curie university-Paris 6, Sorbonne universites, GRC-08 (EEMOIS), 
      75013 Paris, France; CRI-IMIDIATE clinical research network, 75013, Paris, 
      France; AP-HP, Pitie-Salpetriere hospital, rheumatology department, 75013 Paris, 
      France. Electronic address: bruno.fautrel@aphp.fr.
LA  - eng
SI  - ClinicalTrials.gov/NCT00811343
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180223
PL  - France
TA  - Presse Med
JT  - Presse medicale (Paris, France : 1983)
JID - 8302490
RN  - 0 (Immunologic Factors)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Adult
MH  - Autoimmune Diseases/blood/complications/*drug therapy/immunology
MH  - Cost-Benefit Analysis
MH  - Diagnostic Tests, Routine/*economics
MH  - Female
MH  - Humans
MH  - Immunologic Factors/adverse effects/*therapeutic use
MH  - Interferon-gamma Release Tests/economics
MH  - Latent Tuberculosis/complications/*diagnosis/economics/immunology
MH  - Male
MH  - Mass Screening/*economics/methods
MH  - Middle Aged
MH  - Sensitivity and Specificity
MH  - Treatment Outcome
MH  - Tuberculin Test/economics
MH  - Tumor Necrosis Factor-alpha/*antagonists & inhibitors
EDAT- 2018/02/27 06:00
MHDA- 2018/04/19 06:00
CRDT- 2018/02/27 06:00
PHST- 2016/09/06 00:00 [received]
PHST- 2017/09/15 00:00 [revised]
PHST- 2017/09/28 00:00 [accepted]
PHST- 2018/02/27 06:00 [pubmed]
PHST- 2018/04/19 06:00 [medline]
PHST- 2018/02/27 06:00 [entrez]
AID - S0755-4982(18)30014-9 [pii]
AID - 10.1016/j.lpm.2017.09.029 [doi]
PST - ppublish
SO  - Presse Med. 2018 Feb;47(2):e9-e13. doi: 10.1016/j.lpm.2017.09.029. Epub 2018 Feb 
      23.