PT  - JOURNAL ARTICLE
AU  - Ang, Marcus
AU  - Nguyen, Hai V
AU  - Kiew, Sieh Yean
AU  - Chen, Shu
AU  - Chee, Soon-Phaik
AU  - Finkelstein, Eric
TI  - Cost-effectiveness of alternative strategies for interferon-γ release assays and tuberculin skin test in tuberculous uveitis
AID  - 10.1136/bjophthalmol-2014-306285
DP  - 2015 Jul 01
TA  - British Journal of Ophthalmology
PG  - 984--989
VI  - 99
IP  - 7
4099  - http://bjo.bmj.com/content/99/7/984.short
4100  - http://bjo.bmj.com/content/99/7/984.full
SO  - Br J Ophthalmol2015 Jul 01; 99
AB  - Background Although tuberculous uveitis remains a major cause of ocular morbidity in the developing world, there is no consensus on which diagnostic test or testing strategy is the most cost effective. In this study we carried out a cost-effectiveness analysis to determine the most cost-effective diagnostic test strategy.Methods In this prospective study, we recruited 102 patients from Singapore National Eye Centre with signs suggestive of tuberculous uveitis. Using prospective data from this cohort and from published meta-analyses, we modelled the incremental cost effectiveness of the following strategies: tuberculin skin test (TST) only; interferon-γ release assay (IGRA) only; IGRA following a positive TST result; and dual-test strategy, conducting TST and IGRA at presentation. Incremental cost-effectiveness ratios (ICERs) were calculated for each strategy and analysed using a willingness-to-pay threshold of $50 000 per quality-adjusted life year (QALY) gained.Results In our population, the least cost effective was the IGRA-only strategy. The dual-test strategy was the most cost effective, with an improvement of 0.017 QALY at an incremental cost of $190 relative to the TST-only strategy (ICER $11 500); while the TST-only strategy was more cost effective than the third strategy, using IGRA following a positive TST result (ICER $3610). This remained consistent while varying the costs of IGRA and TST, the incidence of tuberculosis and tuberculous uveitis, as well as the diagnostic accuracy of IGRA and TST found in previous studies in various populations.Conclusions The dual-test strategy (performing TST and IGRA at presentation) was the most cost effective strategy for the diagnosis of tuberculous uveitis in our population.