When the 2006 NICE TB Guidelines were published
Professor Peter Ormerod, a member of the NICE Guideline Development Group, had
this to say
The sooner TB is diagnosed, the easier it is to treat. This guideline is not about pointing the finger at the non-UK born who are disproportionately affected by TB, but is about making sure those who have active TB are identified as soon as possible so they can be offered access to treatment as quickly as possible, which both treats their TB and breaks the cycle of transmission between people.”
He also
advised that the Guidelines, which were essentially cost based, found economic limitations with IGRA
IGRA testing alone is ONLY cost effective if LTBI rate 40% or greater
Then
came the
volte-face
results, reported at the 2007 BTS Winter meeting for this purpose, certainly for QFT showed very substantial cost savings (the year 2 data are even stronger). Essentially the ‘neutral’ cut off point is an 8% false positive tuberculin test rate, if more than 8% have a negative QFT then there is net saving which increases with the proportion of negative IGRA testing.
Some revision of existing TB policies has produced ‘
Rethinking TB screening: politics, practicalities and the press’
The ideal screening process would achieve three aims. First, it would identify the small number with active TB disease; they are in need of treatment both for their own benefit and because some may be infectious to others. Secondly, it would identify those with latent TB infection. In these, intervention with drug treatment would substantially reduce, but not remove completely, the risk of later progression to active TB disease..
...The present system is not adequate, and the ‘status quo’ is no longer a sensible or scientific position,
Professor Ormerod is now being
quoted in the press
rather than giving new arrivals to the UK chest x-rays as standard practice, targeted blood testing should be the main strategy...
...Professor Ormerod said: “The aim is to try and find people who have been infected but are perfectly well, to try and treat them so they do not become ill later in life.
We want targeted chest x-rays on people who haven't passed a blood test, not chest x-rays for everybody.
These cost money and are not always necessary.”
The doctor wants these new recommendations to be accepted as part of National Institute for Health and Clinical Excellence (NICE) guidelines, and will be promoting this idea as an adviser to NICE.
