Abstract
This study aimed to analyze the cost-effectiveness of three tuberculosis (TB) antigen-based skin tests (TBST) (Diaskintest, C-TST, and Cy-TB) and QFT-Plus for TB infection diagnosis compared to the current standard of care, PPD Rt-23 tuberculin skin test (TST), among healthcare workers in Brazil. A state-transition Markov model was employed, simulating a cohort of healthcare workers (five annual cycles) for testing and treating TB infection with three months of weekly doses of rifapentine and isoniazid (3HP) under the Brazilian public health system perspective. Effects (TB disease averted) and costs for screening and treating TB infection were discounted at 5%. Incremental cost-effectiveness per TB averted was estimated. One-way and probabilistic sensitivity analysis were performed. Brazil, an upper-middle-income country with a high burden of TB, shows one of the largest universal public health systems and provides free-of-charge diagnosis and treatment for TB and TB infection. TST is the standard of care, whereas QFT-Plus is available for very high-risk populations. The three new TBST are under validation for eventual incorporation. Patients or participants: a hypothetical cohort of 10,000 healthcare workers, working at any level of healthcare service, and negative TST results in the previous year of both sexes with a baseline negative TST result. Diaskintest, C-TST, Cy-TB, and QFT-Plus were found to show a higher specificity. Costs with QFT-Plus were higher due to equipment, human labor, and test price. Diaskintest was the most cost-saving strategy, followed by Cy-TB for TB preventive treatment with 3HP. In the Brazilian scenario, Diaskintest and Cy-TB are the most cost-effective tests for sequential testing of healthcare workers.