The T-SPOT®.TB test is a cost effective solution for TB screening when compared to the significant costs associated with the tuberculin skin test (TST). Total costs for the tuberculin skin test are often believed to be lower than the actual cost. According to a published study by Lambert et al., the total cost of a tuberculin skin test per healthcare worker tested ranged from $41.00 to $362.00.¹
The source of many of the costs for the tuberculin skin test include:
Procedural:
- Two visits are required, one for administration of the PPD and the second for interpretation of the test result.
- Subjectivity of test administration and interpretation of results
Operational:
- Training and retraining in proper test administration and interpretation
- Getting the HCW to return for the second visit
- Following up on those HCWs who do not return for the second visit
- Two-step testing for new employees requires a total of four visits
Performance:
- The TST cross-reacts with the BCG vaccine resulting in false-positive results
- TST results are affected by immunosuppression resulting in false-negative results²
The T-SPOT.TB test addresses the sources of these costs associated with the TST:
- Single blood test, only one visit required
- The T-SPOT.TB test results are not affected by immunosuppression or BCG vaccine3
- Comprehensive TB Testing Coverage: the ability to test all patients and HCWs with the T-SPOT.TB test
In addition,the CPT code, 86480, has been established. The code is described as "Tuberculosis test, cell mediated immunity measurement of gamma interferon antigen response."4,5
The table below highlights the most significant cost savings:
| |
T-SPOT.TB
|
TST
|
|
Annual Healthcare Worker (HCW) Screening
|
One Visit
- HCW Time
- Phelbotomist Time
|
Two Visits
- HCW time initial visit
- Nurse labor for administration
- HCW time for return visit
- Nurse labor for interpretation
|
New HCW
screening |
One Visit
- HCW time
- Phelbotomist time
|
Four visits
(Two-step testing)*
1st Test:
- HCW time initial visit
- Nurse labor for administration
- HCW time for return visit
- Nurse labor for interpretation
2nd Test:
- HCW time initial visit
- Nurse labor for administration
- HCW time for return visit
- Nurse labor for interpretation
*where applicable
|
| Patient Testing |
One Visit
- Patient time
- Phlebotomist time
|
Two Visits
- Patient time initial visit
- Nurse labor for return visit
- Patient time for return visit
- Nurse labor for interpretation
|
BCG vaccinated
Patient or HCW |
Results are not affected by BCG vaccine |
Cross-reacts with BCG vaccine
Cost of false positive result
- Chest x-ray
- Unnecessary treatment and follow-up
|
| Immunosuppressed Patient or HCW |
Results are not affected by immunosuppression |
Results are affected by immunosuppression
Cost of false negative result
- Missed cases convert to TB disease leading to morbidity and higher costs of treating disease
|
Subjects miss
clinics |
Only one visit
required |
Two visits are required. Up to one third of subjects do not return for test interpretation
|
| Un-used reagents |
Only use sufficient reagents for each test |
PPD must be used within one day of opening. Un-used PPD is discarded
|
1Lambert L et al., Costs of Implementing and Maintaining A Tuberculin Skin Test Program in Hospitals and Health Departments. Inf Con and Hosp Epidem 2003: 814-820.
2Lee J et al., Comparison of two commercial interferon-gamma assays for diagnosing Mycobacterium tuberculosis infection. Eur Respir J 2006: 28: 24-30.
3T-SPOT.TB Pivotal Clinical Study. T-SPOT.TB results were not associated with immunocompromised status. T-SPOT.TB Package Insert.
42009 Clinical Laboratory Fee Schedule
5Oxford Immunotec Inc. does not make any recommendations or representation of use for any particular reimbursement code for any given test. The choice of reimbursement code used is the sole responsibility of the practioner or billing entity.
