Table 5.
Cost-effectiveness of six TB screening strategies for a cohort of 1000 healthcare workers over 20 years: alternate scenario with increased worker risk
| Strategy | Cost in 2015 $Can | Incremental cost | QALYs | Increment in QALYs | Incremental cost per QALY gaineda | New active TB cases | Increment in active TB cases prevented | Incremental cost per additional TB case preventeda |
|---|---|---|---|---|---|---|---|---|
| Post-exposure screening only | ||||||||
| Tuberculin Skin Test | $198,480 | — | 15,234.05 | — | — | 8.90 | — | — |
| QuantiFERON®-TB-Gold | $228,809 | $30,329 | 15,233.75 | –0.30 | — (Dominatedb) | 8.73 | 0.17 | — (Extended dominancec) |
| Targeted screening | ||||||||
| Tuberculin Skin Test | $257,670 | $59,190 | 15,232.84 | –1.22 | — (Dominatedb) | 8.18 | 0.55 | $52,552 |
| QuantiFERON®-TB-Gold | $365,397 | $166,917 | 15 231.90 | –2.15 | — (Dominatedb) | 8.23 | –0.05 | — (Dominatedb) |
| Annual screening | ||||||||
| Tuberculin Skin Test | $487,837 | $289,357 | 15,227.38 | –6.68 | — (Dominatedb) | 7.64 | 0.54 | $426,678 |
| QuantiFERON®-TB-Gold | $868,662 | $670,182 | 15,223.94 | –10.11 | — (Dominatedb) | 7.95 | –0.31 | — (Dominatedb) |
TB tuberculosis, QALYS quality-adjusted life years
aRelative to next most expensive, non-dominated strategy
bDominated because it is more expensive and less effective than the proposed alternative; hence no ICER is provided
cExtended dominance by the targeted tuberculin skin testing screening strategy, meaning that the incremental cost-effectiveness ratio is in fact lower for the targeted tuberculin skin testing screening strategy, so the targeted strategy is preferred. Hence no ICER is provided