Economic Evaluation of the IGRA Screening Test for the Detection of Micobacterium Tuberculosis Infection: An Analysis for the Italian Health System

OBJECTIVES: To estimate the economic impact due to the use of IGRA test as a screening for healthcare care workers (HCW), compared with the standard of care for the diagnosis of tuberculosis infection (TBI), a budget impact analysis from the perspective of the Italian National Health Service (INHS) was developed.

METHODS: A budget impact analysis (BIA) was conducted to compare the Mantoux test followed by IGRA if the first was positive for all HCW, and IGRA alone. The decision model, according to the sensitivity and specificity of tests, evaluated the two different diagnostic strategies. Both scenarios considered the following costs: tests, health visit, treatment of latent tuberculosis infection and active tuberculosis.

RESULTS: The BIA conducted highlight the economic advantage obtainable thanks to IGRA strategy, given the large number of patients and the consequent impact on the health care system. The use of IGRA alone leads to savings for NHS of about 7 euros per patient, for a total of nearly € 10,300,000, considering approximately 1,404,000 healthcare workers in Italy; the difference in the costs of the tests is largely absorbed by the advantage that can be obtained from the use of IGRA. The analysis underlines, in addition to the economic advantage, the clinical and organizational advantages of IGRA for healthcare services in identifying (and treating) a greater number of infected persons, detecting a higher number of HCW with TBI resulting in a lower risk of developing active tuberculosis. The robustness of the study was demonstrated by the results of the sensitivity analysis.

CONCLUSIONS: The analysis carried out showed how the use of IGRA as a diagnostic strategy for surveillance of TBI in HCW, could have a saving impact on the optimization of resource consumption for the INHS, representing an effective and safe diagnostic option.