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"documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2015;145:419-26" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "The relationship between physical activity in leisure time and the ankle–brachial index in a general Spanish population: The ARTPER study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "419" "paginaFinal" => "426" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Relación entre actividad física en el tiempo libre y el índice tobillo-brazo en población general española: estudio ARTPER" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1167 "Ancho" => 1742 "Tamanyo" => 91079 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Association between stratified ankle–brachial index and leisure time physical activity in <span class="elsevierStyleItalic">metabolic energy turnover</span> for 14 days. 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"S0025775315000743" "doi" => "10.1016/j.medcli.2015.01.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315000743?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616002138?idApp=UINPBA00004N" "url" => "/23870206/0000014500000010/v1_201604230100/S2387020616002138/v1_201604230100/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Comparative study of concordance and costs between tuberculin skin test and QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "432" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Xavier Martinez Lacasa, Roser Canals Font, Angels Jaen Manzanera, Eva Cuchi Burgos, Josep Lite Lite" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Xavier" "apellidos" => "Martinez Lacasa" "email" => array:1 [ 0 => "xmartinez@mutuaterrassa.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Roser" "apellidos" => "Canals Font" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Angels" "apellidos" => "Jaen Manzanera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Eva" "apellidos" => "Cuchi Burgos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Josep" "apellidos" => "Lite Lite" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unitat de Control de Tuberculosis, Servei de Medicina Interna, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Fundació Recerca Mútua Terrassa, Terrassa, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CatLab, Terrassa, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio comparativo de concordancia y costes entre la prueba de la tuberculina y QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube en el diagnóstico de la infección latente tuberculosa en contactos de pacientes con tuberculosis pulmonar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Latent tuberculosis infection (LTBI) is traditionally defined as a positive skin test (tuberculin skin test [TST]) without clinical or radiographic evidence of active disease.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">1</span></a> However, the TST has its limitations, such as false positive results in patients who have been previously infected with nontuberculous mycobacteria. However, the main interference is found in those who have been vaccinated with Bacillus Calmette-Guerin (BCG).<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">2–4</span></a> False positives in TST result in treating patients who are not actually infected, with the consequent risk of potential toxicity.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">5</span></a> This can be a major problem in countries or communities where BCG vaccination is routinely performed or in those receiving immigrants from these countries. In this regard, in recent decades, Spain has been a receiver of immigrants from countries with a high incidence of tuberculosis (TB), and in most cases with universal vaccination programmes established.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">6</span></a> In connection with this, it is also worth mentioning that some autonomous communities in our country were implementing universal BCG vaccination until just a few years ago.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently, there are blood tests available which are based on in vitro detection of interferon-γ (IFN-γ) γ (IGRA, “Interferon Gamma Release Assayγ”). This test measures the IFN-γ released by T cells of the patient following stimulation with specific TB antigens. There are 2 techniques available: the QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube (QF-G-IT) and T-SPOT test.<span class="elsevierStyleItalic">TB</span><a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">8–11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">According to existing reviews, the IGRA have high specificity, which is unaffected by previous BCG vaccination. Thus, false positives for this reason are unlikely.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">12</span></a> In areas with low vaccination incidence, IGRA results correlate well with exposure related markers.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">13,14</span></a> Furthermore, IGRA have several advantages over the TST: IGRA requires only one patient visit and eliminates the <span class="elsevierStyleItalic">booster</span> effect possibility when the test is repeated (if old prior infection or cross-reaction with other NTM), which is very interesting in some risk groups, such as, for example, in the case of healthcare personnel.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, IGRA may have some disadvantages, such as the high cost of the materials, the need for a well-equipped laboratory, the requirement to obtain the blood sample and careful handling to maintain lymphocyte viability.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">15</span></a> Although the <span class="elsevierStyleItalic">booster</span> effect risk is eliminated when retesting at a later stage, there is a chance of diversity in the results, something that has not been well analysed.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">16</span></a> Also, there seems to be a window period in case of very recent infection, which could be similar to the TST, although it is not yet known in detail.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">16</span></a> In fact, serial studies of this test have shown high rates of both, conversions and reversions, in exposed populations, and the of prognosis conversions and reversions is unknown.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">17</span></a> This is especially true in cut-off values for positive QF-G-IT.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Currently, no data exist to determine the appropriate time to do the test with IGRA in exposed contacts and the same criteria followed for TST is applied.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Given the lack of published data regarding the sensitivity and specificity of QF-G-IT in children, the CDCs recommend to be cautious in interpreting the test in those under 16 years of age. In addition, the CDCs also recommend caution in close contacts who are at particular risk for progression to TB disease (children under 5 years of age and immunocompromised individuals). As in the case of the TST, an IGRA negative result does not rule out LTBI at an early age and even TB disease, a fact that is particularly important in these high-risk populations.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">19</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">While some QF-G-IT benefits are clear on the TST, there is debate in the medical literature on what should be considered the technique of choice in the diagnosis of LTBI. The controversy has to do with the cost of the different study techniques and there is no clear consensus.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The overall objective of this study is to compare the TST and the QF-G-IT in the context of a cohort of contacts of patients diagnosed with lung TB in our centre. The specific objectives are: to determine the agreement between tests and the effect vaccination has on them, and make a comparative economic study in order to determine the most cost-effective in detecting LTBI, in the context of routine clinical practice. This cost-benefit analysis is of particular interest.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">Comparison study of diagnostic tests performed between September 2010 and October 2011. The study population were contacts of patients diagnosed with pulmonary TB during this period and within the reference geographic area of the Mutua Terrassa University Hospital. The selection of the contacts for the study was done in accordance with the recommendations of the contact study consensus document (Tuberculosis Investigation Unit of Barcelona [UITB] Study Group)<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">20</span></a> following the model of “concentric circles”, classifying contacts into 3 categories: (a) <span class="elsevierStyleItalic">cohabitants</span>: individuals who are part of the same household or are exposed daily to the index case for ≥6<span class="elsevierStyleHsp" style=""></span>h within closed spaces; (b) <span class="elsevierStyleItalic">common</span>: those exposed daily <6<span class="elsevierStyleHsp" style=""></span>h within closed spaces, and (c) <span class="elsevierStyleItalic">occasional</span>: individuals with less exposure than the previous circle. The study was done systematically in all individuals belonging to the first and second circles. The study was extended to the third circle when a high prevalence of infection or secondary cases of TB was found in the second circle. The study included two stages. In the first stage (coinciding with the date of diagnosis of the index case), QF-G-IT and TST tests were performed to all contacts simultaneously. In the second stage (6–8 weeks after the first), tests were repeated if they had been initially negative and if the period since the end of exposure to the index case was less than 8 weeks.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Active disease was ruled out in all cases where any of the tests was positive by performing a chest radiography and techniques that were considered appropriate to each case.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The following baseline characteristics of the patients were collected: age, sex, country of origin, living with the index case, degree of relationship with the index case, BCG vaccine history, history of previous TST and presence of associated diseases. Regarding the index case, data were collected on whether it was bacilliferous or not and whether the patient had concomitant HIV infection.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The criterion for selection of vaccinated patients was strict, either through a clear identification of the vaccine mark or through certified information of its administration.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Those study contacts who were infected with HIV (known fact) were discarded, as well as children under 16 years of age (in these groups of patients QF-G-IT has not proven to be a standard technique).</p><p id="par0070" class="elsevierStylePara elsevierViewall">The contacts received follow-up during 2 years.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The technical aspects of both tests are explained next:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">TST (Mantoux)</span>: the Mantoux technique was used to perform the TST, (with 2-TU of PPD RT23 with TWeen 80), and the result was evaluated 72<span class="elsevierStyleHsp" style=""></span>h later by experienced staff. An induration ≥5<span class="elsevierStyleHsp" style=""></span>mm in the case of cohabiting persons or common contacts and 10<span class="elsevierStyleHsp" style=""></span>mm in the case of sporadic contacts, was considered positive; all independently from the BCG vaccine.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">QF-G-IT</span>: QF-G-IT test was made according to the manufacturer's instructions. 1<span class="elsevierStyleHsp" style=""></span>ml of blood was directly introduced into 3 heparinized tubes: a negative control containing only heparin, a tube with a mitogen (phytohemagglutinin) and a tube with ESAT-6, CFP-10 and TB7.7 (Rv2654) antigens. Each tube was shaken several times until a homogeneous mixture was obtained. The tubes were introduced in an incubator at 37<span class="elsevierStyleHsp" style=""></span>°C no later than 2<span class="elsevierStyleHsp" style=""></span>h from blood collection. After 24<span class="elsevierStyleHsp" style=""></span>h of incubation, the tubes were centrifuged and plasma was collected. The amount of IFN-γ was measured by ELISA reagents, included in the kit. The result was considered positive when the IFN-γ was ≥0.35<span class="elsevierStyleHsp" style=""></span>U/ml after subtracting the negative control. The result was considered inconclusive with IFN-γ ≤0.35<span class="elsevierStyleHsp" style=""></span>U/ml (after subtracting the negative control) and the mitogen's IFN-γ minus the negative control was ≥0.50<span class="elsevierStyleHsp" style=""></span>IU/ml and/or with IFN-γ >0.8<span class="elsevierStyleHsp" style=""></span>U/ml in the negative control.</p></li></ul></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">The agreement between the QF-G-IT and TST tests was calculated using the kappa statistic. In the stratified analysis, if the information about a subject's vaccination was unknown, they were excluded. The differences in frequencies were evaluated by the Fisher's exact test. Statistical calculations were performed using the statistical package Stata/SE, version 9. Statistical significance was defined by a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.05.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Cost and diagnostic strategies study</span><p id="par0095" class="elsevierStylePara elsevierViewall">A detailed cost analysis of each test was carried out, evaluating both the direct cost of each technique as well as the indirect costs derived from the labour cost per hour of the professionals involved, as well as visits made and travelling expenses.</p><p id="par0100" class="elsevierStylePara elsevierViewall">On the one hand, the <span class="elsevierStyleItalic">technique's own cost</span> concept was defined, which included the costs of the disposable material needed to perform the technique and the proportional labour cost (price/h) of the healthcare professional responsible for carrying out such techniques and, in the case of the TST, the reading. In the case of TST, 15<span class="elsevierStyleHsp" style=""></span>min were estimated to perform the technique and reading. In the case of QF-G-IT, the total time to perform the technique for 28 samples was one hour.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">global cost</span> concept was also defined, which included the cost of the technique itself plus expenses derived from the LTBI treatments in each of the guidelines. In this concept, we took into account the costs of a compulsory chest radiograph in the positive contacts for any of the 2 techniques in order to rule out active TB before treatment of LTBI. We have dismissed the labour costs of the people who undertake the different tests, as well as the travelling expenses, because all this complicates the analysis. However, we must think of the so-called social cost to the companies and to the workers when they have to travel to the hospital to perform certain tests, having to leave their jobs. The travel expenses have been added. All these expenses would be even more damaging to the TST, as two different visits are needed.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Finally, an economic study of the 2 diagnostic strategies in the contact study was carried out based on each of the techniques, in order to see which one was the most cost-effective.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">A total of 101 contacts were analysed, of which 52 (52.2%) were male. The average age of the contacts was 38.9 years (SD 12.4). With regard to contacts in relation to the index cases, 21/101 (21.2%) were from patients with pulmonary TB smear-negative for bacilli, while 80/101 (80.2%) were smear-positive contact patients. Finally, 12/101 (12.2%) were contacts whose index case was an HIV-infected patient with TB, while 89/101 (89.2%) were contacts of patients with TB without concomitant HIV infection.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Regarding the country of origin, 58/101 (58.2%) contacts were born in Spain versus 43 (43.2%) born in other countries, with 27/101 (27.2%) from the Maghreb, followed by 11/101 (11.2%) from Latin America.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Regarding the degree of cohabitation, 52/101 (52.2%) contacts were considered as cohabitants, 14 as frequent and 35 as sporadic.</p><p id="par0130" class="elsevierStylePara elsevierViewall">A total of 40/101 (39.6%) cases had a documented history of BCG vaccination, while in 18 cases there were doubts, so they were considered negative.</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Analysis of the techniques studied</span><p id="par0135" class="elsevierStylePara elsevierViewall">A total of 61/101 (59.6%) contacts with positive TST were recorded; of them, 10 cases had a TST between 5 and 10<span class="elsevierStyleHsp" style=""></span>mm, 25 had the TST between 11 and 14<span class="elsevierStyleHsp" style=""></span>mm and in 26 cases, the TST was equal or over 15<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding QF-G-IT, 42/101 (41.6%) were positive contacts. Of all the controls made, only one was inconclusive.</p><p id="par0145" class="elsevierStylePara elsevierViewall">By studying the results of the techniques according to the contacts history of BCG vaccination (yes or no), we noted that the TST was positive in 34/40 (85%) versus 24/40 (60%) with positive QF-G-IT. In the group of patients which was not vaccinated with BCG, TST was positive in 18/61 (29%), while QF-G-IT was positive in 13/61 (21.3%).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Analysis of agreement</span><p id="par0150" class="elsevierStylePara elsevierViewall">An analysis of agreement was first conducted between the two tests in the overall sample, and then, the same analysis was performed on both, the population with and without a history of BCG vaccination.</p><p id="par0155" class="elsevierStylePara elsevierViewall">In the overall analysis, and as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, the agreement between the TST and the QF-G-IT was 79.0%, with a kappa of 0.60. There was only one case where the QF-G-IT was positive with a negative TST, while 19 cases were found of positive TST with negative QF-G-IT.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">When we analysed the agreement between the two techniques <span class="elsevierStyleItalic">in patients vaccinated with BCG</span>, we observed that it decreases significantly, being 75%, with a kappa of 0.42. It is worth mentioning that no patient with a negative TST showed a positive QF-G-IT. However, the agreement analysis in the unvaccinated group shows an agreement of 85.7%, with a kappa of 0.70. There was only one case of positive QF-G-IT in a negative TST contact.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Technique economic study</span><p id="par0165" class="elsevierStylePara elsevierViewall">The economic costs and various concepts considered in the economic study related to the techniques used in the diagnosis of LTBI which are based either on the TST or on the QF-G-IT, are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> (first and second block). The cost per person and treatment of the LTBI is shown in the third block.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">The cost-effectiveness results based on the diagnosis and treatment of LTBI as per the 2 tests are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. The most cost-effective strategy, in our case, is based on QF-G-IT, with a total cost of €7827.92, compared to the cost of €8095.55 of the TST for 101 contacts studied.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">In our contact cohort with TB patients, a moderate agreement between the TST and QF-G-IT for the diagnosis of LTBI was found, mainly due to the group of vaccinated contacts. In contrast, unvaccinated patients show a high agreement between tests. With regard to the economic study on the diagnosis of LTBI, for both strategies, and taking into account the costs of the entire LTBI process of care and treatment, QF-G-IT is shown as the most cost-effective strategy. Besides, it also avoids the potential adverse effects and impact on quality of life of an unnecessary treatment due to false positive TST in vaccinated patients.</p><p id="par0180" class="elsevierStylePara elsevierViewall">In July 2005, the CDC recommended that QF-G-IT could be used in all circumstances in which the TST is currently used, including contact investigations, evaluation of recent immigrants and epidemiological surveillance in certain groups for infection control, for example, health care workers, etc.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">21</span></a> This recommendation was also reinforced by the <span class="elsevierStyleItalic">National Tuberculosis Controllers Association</span> in the case of contact studies.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">22</span></a> According to these recommendations, the QF-G-IT can be used instead of, not in addition to, the skin test during the study of the contacts.<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">23–25</span></a> A positive QF-G-IT result should be interpreted similarly to the TST, considering the infected patient.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">21,22</span></a> According to these recommendations there is no reason to perform a TST before or after a positive QF-G-IT result.</p><p id="par0185" class="elsevierStylePara elsevierViewall">However, other authors have suggested intermediate strategies, in which the TST would continue to be the initial choice test and IGRA would be used to confirm positive TST results.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">26–28</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Even other authors or medical societies have openly advocated to maintain the universal use of TST and IGRA in special situations.<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">29–31</span></a> The fundamental criterion for this method is primarily related to the cost-effectiveness relationship for both techniques, taking into account that the TST is less expensive.<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">32–35</span></a> This approach, which may seem correct if we evaluate only the direct costs of both techniques, has been challenged by the cost-effectiveness studies published by different research projects in recent years.<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">33–38</span></a> In our study, as expected, the TST technique is cheaper than the QF-G-IT, which is explained by the low costs of the TST, based on a simple intradermal inoculation. In contrast, the QF-G-IT requires an accurate processing of the blood sample in the laboratory followed by performing the technique itself, which is usually done in kits containing up to 28 tests per plate. However, the calculation of the actual costs of this test, considering all the variables, such as necessary visits for reading, the associated cost of nonadherence to the reading and also the costs for the patient, increases its value. Given the results of our study, in 100 patients there is a saving of €265, which extrapolated to 1000 patients could save €2650. Apart from the economic aspect, an essential factor in our opinion is the number of treatments that can be avoided thanks to using the QF-G-IT technique, which in our case reached 20% of the contacts. This is where the IGRA clearly demonstrates its cost-effectiveness in contact patients.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Our results are in line with the most recent studies, which show that the QF-G-IT is at least as cost-effective as the TST, and more cost-effective if the patient is not adherent to the TST reading visit, which occurs frequently.<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">36–40</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Our data are similar to those found in other studies<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">41</span></a> as it coincides with the fact that the QF-G-IT is a very useful technique in detecting LTBI and also has a good correlation with TST, especially in the case of BCG unvaccinated contacts. Also, it has a very good specificity in the case of a negative result. The agreement was lower, predictably, in the vaccinated group, where the QF-G-IT detected false positives in TST due to the vaccine. In the unvaccinated group there is a remarkable improvement in agreement as the false positives in TST decrease. According to agreement, sensitivity and specificity criteria, the QF-G-IT should be considered, in our view, the test of choice (<span class="elsevierStyleItalic">gold standard</span>) for LTBI screening in cases of contacts with pulmonary TB patients.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Although our cohort of contacts is not very large and is limited to our centre, it is representative of the geographic area of reference and these results should not be different from those obtained by other groups in general, especially in our country, as similar protocols are followed, protocols which we have taken into account when conducting the cost analysis.</p><p id="par0210" class="elsevierStylePara elsevierViewall">We have observed a higher cost-benefit in the diagnostic strategy of the contact study based on QF-G-IT, even when the number of people analysed was not very high. Extrapolating larger populations, especially if there is a high percentage of vaccinated subjects in the same, these differences would be expected to be higher in favour of QF-G-IT. We recommend using the QF G-IT as a diagnostic technique of choice for detecting LTBI in adult contacts with pulmonary TB patients, especially if they are cohabiting and the index case is smear-positive for bacilli, avoiding the TST.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financial support</span><p id="par0215" class="elsevierStylePara elsevierViewall">This work was financially supported by <span class="elsevierStyleGrantSponsor" id="gs1">Hospital Universitari Mutua Terrassa</span> Research Grant, 2010.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres630785" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec643603" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres630786" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec643604" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Cost and diagnostic strategies study" ] ] ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Analysis of the techniques studied" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Analysis of agreement" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Technique economic study" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Financial support" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-06-10" "fechaAceptado" => "2014-11-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec643603" "palabras" => array:6 [ 0 => "Pulmonary tuberculosis" 1 => "Tuberculin skin test" 2 => "Interferon-γ release assays" 3 => "QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube" 4 => "Concordance analysis" 5 => "Cost-effectiveness analysis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec643604" "palabras" => array:6 [ 0 => "Tuberculosis pulmonar" 1 => "Prueba de la tuberculina" 2 => "Análisis de liberación del interferón-γ" 3 => "QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube" 4 => "Estudio de concordancia" 5 => "Estudio de coste beneficio" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recently diagnosis of latent tuberculosis infection (LTBI) can be made using the tuberculin skin test (TST) or by techniques known as interferon-γ release assays (IGRAS), being QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube (QF-G-IT) the most used. The IGRAS avoid some drawbacks of the TST, especially cross-reaction with bacillus Calmette-Guérin (BCG) vaccine, but also present some problems such as those arising from cost and the need of having an adequate infrastructure and experience. There is no clear consensus on which technique should be preferentially used for the diagnosis of LTBI.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a comparative study between the TST and QT-G-IT in a cohort of contacts of patients with pulmonary tuberculosis during the study period. An analysis of global agreement and groups was performed according to whether the contacts were vaccinated with BCG or not. A study of costs of both techniques and diagnostic strategies based on these techniques was performed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The agreement between TST and QF-G-IT was acceptable in the whole sample yet it was very good in the unvaccinated group. Few cases of indeterminate values were recorded. The cost study showed that TST was cheaper than QF-G-IT; however when we analysed the cost of the strategies according to each technique, the QF-G-IT showed a better cost-benefit.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We suggest considering QF-G-IT as the only preferred technique for the diagnosis of LTBI in household contacts, based on good overall agreement between the 2 techniques (even if we eliminate the effect of the vaccine) and a cost analysis favourable to QF-G-IT.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El diagnóstico de la infección latente tuberculosa (ILT) es posible realizarlo mediante la prueba de la tuberculina (PT) o bien a través de las denominadas técnicas de <span class="elsevierStyleItalic">interferon-γ release assays</span> (IGRAS, «análisis de liberación del interferón-γ»), siendo QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube (QF-G-IT) la más usada. Los IGRAS permiten evitar algunos inconvenientes de la PT, especialmente la reacción cruzada con la vacuna con bacilo de Calmette-Guérin (BCG). No obstante, también presentan algunos problemas, como son los derivados del coste de la técnica, así como el ser un método de laboratorio que precisa una infraestructura y experiencia adecuadas. No existe un claro consenso sobre cuál de las técnicas debería utilizarse de forma prioritaria para el diagnóstico de la ILT.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio comparativo entre la PT y la QF-G-IT en nuestra cohorte de contactos de pacientes con tuberculosis pulmonar durante el período de estudio (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>101). Se realizó un análisis de la concordancia global y por grupos según los contactos estuvieran vacunados con BCG o no. Se realizó, además, un estudio de costes de ambas técnicas y de las estrategias diagnósticas basadas en ellas.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La concordancia entre la PT y la QF-G-IT fue aceptable en el global de la muestra, pero muy buena en el grupo de no vacunados. Se registraron muy pocos casos de valores indeterminados. El estudio de costes mostró que la PT era más económica que la QF-G-IT; sin embargo, al analizar el coste de las estrategias según cada técnica, la PT mostró un mayor coste-beneficio.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Aconsejamos considerar QF-G-IT como la única y preferente técnica para el diagnóstico de la ILT en contactos convivientes, basados en una buena concordancia general entre ambas técnicas (más aún si eliminamos el efecto de la vacuna) y un estudio de costes favorable a QF-G-IT.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0060">Please cite this article as: Martinez Lacasa X, Canals Font R, Jaen Manzanera A, Cuchi Burgos E, Lite Lite J. Estudio comparativo de concordancia y costes entre la prueba de la tuberculina y QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube en el diagnóstico de la infección latente tuberculosa en contactos de pacientes con tuberculosis pulmonar. Med Clin (Barc). 2015;145:427–432.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Data expressed as n (%).</p>" "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">TST \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">QF-G-IT</th><th class="td" title="table-head " align="left" valign="top" scope="col">Unknown \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">+ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">− \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">1.1 Agreement study in all the cases studied</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (67.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (31.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (61) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (66.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">42 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">57 (57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">100 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034910.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">QF-G-IT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TST</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">+ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">− \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">1.2 Agreement study between the TST and the QF-G-IT, in vaccinated</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (70.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (60) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (29.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (37.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (40) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">34 (85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">6 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">40 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034912.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">QF-G-IT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">TST</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">+ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">− \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">1.3 Agreement study between the TST and the QF-G-IT, in unvaccinated</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (70.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (30.95) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (23.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (66.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (5.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.38) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (40.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (59.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034914.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Kappa<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.597 (standard error: 0.092); <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.00001.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Kappa<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.419 (standard error: 0.129); <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Kappa<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.701 (standard error: 0.146); <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Result of the TST and QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube in the total study population and by groups (vaccinated and unvaccinated).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Second visit (72<span class="elsevierStyleHsp" style=""></span>h) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Block 1. Economic study of TST</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Worker time<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nurse time<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Syringe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0634 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PPD vial<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">10.1834 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">11.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">21.6934 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034915.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Block 2. Economic study of QF-G-IT</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Worker time<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nurse time<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tubes<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">f</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.76 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Extraction needle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.092 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tube holder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dressing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.043 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lab technique \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top" style="border-bottom: 2px solid black">38.225 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034911.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">×3 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Block 3. Economic study of the treatment of LTBI (per person treated)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Worker time<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">g</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Doctor's visit and nurse time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tubes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1678 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5034 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Extraction needle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.092 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.276 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tube holder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dressing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.043 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.129 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lab technique<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">h</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cemidon<span class="elsevierStyleSup">®</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.6528 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034916.png" ] ] ] "notaPie" => array:8 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">It includes transfer (10<span class="elsevierStyleHsp" style=""></span>min) on the first visit and reading time. On the second visit, 5<span class="elsevierStyleHsp" style=""></span>min are assigned for reading.</p>" ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">It includes the time required for the injection and recording data on the first visit; worker search, reading and recording data in the second.</p>" ] 2 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">1.5<span class="elsevierStyleHsp" style=""></span>PPD vial ml: 16.02<span class="elsevierStyleHsp" style=""></span>€. For 14 tests: 1.14<span class="elsevierStyleHsp" style=""></span>€; 0.43<span class="elsevierStyleHsp" style=""></span>€/min. Weighted price as per HUMT (Hospital Universitari Mútua Terrassa) agreement.</p>" ] 3 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Transfer 10<span class="elsevierStyleHsp" style=""></span>min.</p>" ] 4 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">It includes sample collection, data recording and transfer to the laboratory (15<span class="elsevierStyleHsp" style=""></span>min).</p>" ] 5 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "f" "nota" => "<p class="elsevierStyleNotepara" id="npar0045">QF-G-IT tubes: 1–9025 tubes QF-G-IT <span class="elsevierStyleItalic">Blood Collection tubes</span>, 100 units: 695.59<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>VAT<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7.65<span class="elsevierStyleHsp" style=""></span>€; 1–9026 QF mitogen tubes, 100 units: 192.62<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>VAT<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.11<span class="elsevierStyleHsp" style=""></span>€.</p>" ] 6 => array:3 [ "identificador" => "tblfn0050" "etiqueta" => "g" "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Consultation visit during working hours (30<span class="elsevierStyleHsp" style=""></span>min), travelling<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>number of visits.</p>" ] 7 => array:3 [ "identificador" => "tblfn0055" "etiqueta" => "h" "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Liver function test<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3 analytical tests during treatment.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Economic analysis of both guidelines.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Based on TST</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Technique costs: 101<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>21.69<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2191.70<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chest X-ray costs in positive cases: 61<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>244<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Costs derived from TILT in TST: 61<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>92.85<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5663.85<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total: 8099.55<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Based on QF-G-IT</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Costs derived from the technique: 101<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>38.22<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3860.22<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chest X-ray costs in positive cases: 42<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>168<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Costs derived from TILT in QF-G-IT: 42<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>92.85<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3899.70<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total: 7827.92<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034913.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Latent tuberculosis infection screening strategies calculation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib0210" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Avances en el diagnóstico de la infección latente tuberculosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. 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