| Summary: | AIMS: To investigate the yield, and cost effectiveness of testing for TB in a contemporary, HIV-infected population. METHODS: 1. Economic modelling of three LTBI testing strategies of testing HIV clinic attendees using data from two successive periods from the Royal Free Hospital, using univariate, multivariate and probabilistic sensitivity (Monte Carlo) analyses. 2. A prospective cross-sectional study of extensive TB testing in HIV clinic attendees and economic modelling of 30 different strategies using similar methods. RESULTS: 1. From 2000-2010, testing people living with HIV for latent TB infection became progressively less cost-effective. 2. From the prospective study, 219 HIV-infected individuals were recruited between June 2013 and September 2014. No cases of active TB, two cases of subclinical TB and 14 cases of latent TB infection were detected. Modelling 30 differing strategies based on this data, strategies based on UK guidelines were no longer cost effective. Testing with a tuberculin skin test (TST) or single interferon gamma release assay (IGRA) in black Africans, or testing both black Africans and those from middle TB incidence countries with TST were the only cost-effective strategies at under £30,000/QALY. Probabilistic sensitivity analysis results found no testing to be most probably cost-effective up to a threshold of £30,000. 5 CONCLUSION: TB testing has become increasingly less cost-effective over the past decade possibly due to increasing antiretroviral use and changing demographics. Even testing the most high-risk groups is now only marginally cost-effective at the NICE threshold.
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