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The aim of the present study was to assess the cost-effectiveness of the new T-SPOT.TB assay versus the tuberculin skin test (TST) for screening contacts for latent tuberculosis (TB) infection in Switzerland. Health and economic outcomes of isoniazid treatment of 20- and 40-yr-old close contacts were compared in a Markov model over a 20-yr period following screening with TST only (at three cut-off values) and T-SPOT.TB alone or in combination with the TST. T-SPOT.TB-based treatment was cost-effective at (Euro)11,621 and (Euro)23,692 per life-year-gained (LYG) in the younger and older age group, respectively. No TST-based programmes were cost-effective, except at a 15-mm cut-off in the younger group only, where the cost-effectiveness ((Euro)26,451.LYG(-1)) fell just below the willingness-to-pay threshold. Combination of the TST with T-SPOT.TB slightly reduced the total cost compared with the T-SPOT.TB alone by 4.4 and 5.0% in the younger and older groups respectively. The number of contacts treated to avoid one case of TB decreased from 50 (95% confidence interval 32-106) with the TST (10-mm cut-off) to 18 (95%CI 11-43) if T-SPOT.TB was used. Using T-SPOT.TB alone or in combination with the tuberculin skin test for screening of close contacts before latent tuberculosis infection treatment is highly cost-effective in reducing the disease burden of tuberculosis.

To the Editors: A prior study has demonstrated that the rate of indeterminate T-SPOT®. TB (Oxford Immunotec, Abingdon, UK) test results performed under routine field conditions was low (3.4%) [1]. Indeterminate test results were more common in individuals aged >75 yrs and may be influenced by the transport conditions (cold weather in winter). Since this study was published, two technical improvements in the pre-analytic conditions were introduced. The first is the use of lithium heparinate blood sample collection tubes instead of the CPT™ Cell Preparation Tubes with sodium citrate (Vacutainer®; BD, Franklin Lakes, NJ, USA), as used in the prior study; the other is the use of the T-Cell Xtend ™ reagent (Oxford Immunotec) in samples >8 h old [2]. The Meditest reference laboratory (Lausanne, Switzerland) receives blood samples from remote places in Switzerland, so that many samples travel overnight or for ≤36 h before being analysed. All samples that have been collected >8 h earlier are processed with T-Cell Xtend . We therefore performed an updated analysis of the data from the beginning of 2010 to compare the rate of indeterminate tests …

The aim of the present study was to compare the direct costs of three models for detection of latent tuberculosis infection (LTBI) in routine clinical practice in Switzerland. Comparison of the overall costs of screening for LTBI, including medical and radiological examination, and preventive treatment associated with three screening models was carried out. Model 1 relies only on the tuberculin skin test (TST) according to the current national guidelines, model 2 relies on T-SPOT®. TB (Oxford Immunotec, Oxford, UK) only and model 3 relies on TST followed by confirmation of positive results by T-SPOT. TB . Costs were taken directly from the clinic9s figures. Clinical assumptions were based on the 267 patients who were referred to the clinic over the study period. Model 3 was found to be the most cost-effective. Using only the skin test (model 1) was the least cost-effective. If only one test for LTBI is to be used, then model 2 (using T-SPOT. TB only) is cheaper than using the TST (model 1). Screening for latent tuberculosis infection by tuberculin skin test followed by confirmation with T-SPOT. TB is less costly than screening with tuberculin skin test alone, as it allows a reduction in the number of people who receive preventive treatment. In groups with a high proportion of negative tuberculin skin tests, screening with T-SPOT. TB test only may be the most cost-effective.

AIM: Evaluation of first experience of the directly observed therapy (DOT) programme for tuberculosis introduced in the Canton of Vaud in 1997. METHOD: Retrospective analysis of tuberculosis patients included in a DOT programme from October 1997 to March 2000 under the supervision of the TB Dispensary in Lausanne. RESULTS: 54 patients were included, 49 of whom were new cases and 5 relapses. 70% were asylum seekers and illegal immigrants. The indications for DOT were immigrant status, social problems, and physical or psychiatric comorbidities. Treatment was fully supervised in 67% and partially in 33%. The outcome was favourable (cure or treatment completion) in 88.9% and unfavourable in 11.1%. A similar success rate was observed in full and partial DOT and there was no difference in success rates between the various structures where DOT was administered. By comparison, the success rate in a historical group from the same institution was 70% in 1990. The biggest problem was communication with the patients and within the team. CONCLUSION: Treatment of tuberculosis under DOT in the Canton of Vaud resulted in improvement of the treatment success rate.

A large body of evidence underscores the adverse effect of long-term exposure to ambient particulate matter (PM) air pollution on respiratory health (Brunekreef and Forsberg 2005; Gotschi et al. 2008). Among adults in Switzerland, we have previously demonstrated cross-sectionally that residents of more polluted areas have lower lung function (Ackermann-Liebrich et al. 1997). More recently, we presented evidence from the same population-based cohort [Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA)] that decreasing exposure to airborne PM attenuated the average age-related decline in lung function. The associations were strongest for respiratory function tests reflecting small-airway function, namely, FEF25–75 [forced expiratory flow between 25% and 75% of forced vital capacity (FVC)] (Downs et al. 2007). Similar results from studies following interventions such as building bypasses for congested traffic routes (Burr et al. 2004; Hedley et al. 2002) or banning environmental tobacco smoke (ETS) exposure (Goodman et al. 2007; Menzies et al. 2006) showed that the improvements in air quality were accompanied by a decrease in cardiopulmonary mortality and an improvement in respiratory symptoms and lung function. However, it is still unknown whether all subjects benefit equally from a reduction in air pollution. Variation in genes mediating the pathobiological effect of air pollution in the lung may codetermine the degree to which a person benefits from better air quality. Experimental evidence indicates that PM alters expression of tumor protein gene p53, cyclin-dependent kinase inhibitor 1A gene (p21), and the cyclin D1 gene (CCND1) and subsequently affects cell proliferation and apoptosis of lung fibroblasts, lymphocytes, and alveolar epithelial cells (Bayram et al. 2006; Dagher et al. 2006; Nyunoya et al. 2006; Rosas Perez et al. 2007; Soberanes et al. 2006). PM is furthermore well known to induce oxidative stress in the airways (Li et al. 2008). In fact, the expression of all three gene candidates, p53, p21, and CCND1, in bronchial epithelial cells and lung fibroblasts seems to be regulated in part by redox-dependent mechanisms (Jiao et al. 2008; Ranjan et al. 2006; Yao et al. 2008). The tumor suppressor p53, a nuclear transcription factor, binds to response elements in the promoter region of many genes and plays a pivotal role in apoptosis. It induces up-regulation of the expression of many pro-apoptotic genes and down-regulation of anti-apoptotic genes (Oren et al. 2002). CCND1 (cyclin D1) is known to promote cell proliferation through cell cycle G1–S phase transition. The protein p21 (also known as Waf1 or Cip1) is a direct functional counterpart of CCND1 and an important downstream effector of p53 action that negatively regulates cell proliferation. CCND1, p21, and p53 all harbor polymorphisms of hypothesized functional relevance that have been extensively studied in the context of cancer (Choi et al. 2008; Lu et al. 2008; Zhou et al. 2007). In this study, we examined whether these polymorphisms modified the degree to which the age-related FEF25–75 decline was attenuated by reduced exposure to PM with aerodynamic diameter ≤ 10 μm (PM10).