Now that I have the full version of the
cost effectiveness study more detail is at hand.
TB services are under considerable pressure to perform immigrant screening on limited resources. This is on a background of increasing incidence of TB, largely related to cases in immigrant populations. Our service is able to screen ~1200 individuals effectively per annum. There is a need to streamline the screening process for immigrants, firstly to allow our services to operate more efficiently and effectively, and secondly to encourage participation in the screening process amongst immigrants.
I would think that TB services are under pressure everywhere. Leeds Hospital was following NICE guidelines but found that
Due to cost and personnel issues, we are unable to screen all new immigrants from countries with TB incidence >40/100K
They then issued a revised policy
TST was offered to immigrants from countries with TB incidence 200-339/100K, and QFT to those from countries with incidence >340/100K
Amongst the
"well recognised benefits" of QuantiFERON one stood out
in our view the fact that only one contact with healthcare services is required is a major benefit
NICE policy is to use TST first and confirm with a QFT however Leeds found that TST presented false negatives
It is interesting that our protocol identified more cases of LTBI. The increase in cases of LTBI is due to those patients who had a positive QFT but a negative TST and would therefore have been missed by the NICE protocol
They also changed the procedure
We have demonstrated that a QFT-first protocol can be carried out more cheaply than a CXR-first protocol, with a cost saving of ~35%. This saving is due to the reduced number of CXRs required.
It appears that by being innovative Leeds Hospital has found a solution to their funding challenges
we believe that using QFT blood testing followed by CXR is more effective and more cost-effective than NICE guideline for screening new entrants from high risk countries, and will continue to use this approach for immigrant screening.
