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. RESULT S : 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.

Cost-effectiveness, Interferon-gamma release assay, Latent tuberculous infection, Public health resources,
International Journal of Tuberculosis and Lung Disease
Erasmus MC: University Medical Center Rotterdam

Erkens, C.G.M, Dinmohamed, A.G, Kamphorst, M, Toumanian, S, van Nispen-Dobrescu, R, Alink, G.M, … Verver, S. (2014). Added value of interferon-gamma release assays in screening for tuberculous infection in the Netherlands. International Journal of Tuberculosis and Lung Disease, 18(4), 413–420. doi:10.5588/ijtld.13.0589