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Tuberculosis infection tests for contact screening in Brazil: a cost-effectiveness analysis
Fernanda Souza1, Ricardo Steffen2, Marcia Pinto3
1Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Lancet Regional Health. Americas
|March 20, 2026
Summary
The new tuberculosis (TB) antigen-based skin tests (TBST) are cost-saving for diagnosing TB infection in household contacts in Brazil. These TBST offer a more specific and affordable alternative to existing methods.
Area of Science:
- Public Health
- Infectious Disease Diagnostics
- Health Economics
Background:
- WHO recommends three new tuberculosis antigen-based skin tests (TBST) for tuberculosis infection diagnosis.
- Household contacts (HHC) of individuals with pulmonary TB face elevated TBI risk.
- This study assesses the cost-effectiveness of TBST and QFT-Plus® versus TST in Brazil.
Purpose of the Study:
- To evaluate the cost-effectiveness of new TBST and QFT-Plus® compared to TST for diagnosing TB infection in household contacts in Brazil.
- To determine the most cost-saving diagnostic strategy within the Brazilian public health system.
Main Methods:
- A state-transition Markov model simulated four age cohorts of HIV-negative HHC over five years.
- Effectiveness data were sourced from systematic reviews; costs were obtained from Brazilian government and manufacturers.
- Incremental cost-effectiveness analysis was performed to calculate the cost per TB case averted.
Main Results:
- TBST demonstrated similar accuracy to QFT-Plus® and superior specificity compared to TST.
- TBST were less costly than TST and QFT-Plus®.
- All TBST were found to be cost-saving across all age groups, with Cy-Tb® being the most cost-saving.
Conclusions:
- Implementing new TBST for screening HHC in Brazil's public health system presents a cost-saving strategy.
- The existing infrastructure and workforce skills for TST allow for straightforward adoption of TBST.
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