{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T01:11:11Z","timestamp":1794186671496,"version":"4.8.0"},"reference-count":45,"publisher":"FapUNIFESP (SciELO)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cad. Sa\u00fade P\u00fablica"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1590\/0102-311xen178623","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T11:48:23Z","timestamp":1740397703000},"source":"Crossref","is-referenced-by-count":3,"title":["TB antigen-based skin tests and QFT-Plus for Mycobacterium tuberculosis infection diagnosis in Brazilian healthcare workers: a cost-effectiveness analysis"],"prefix":"10.1590","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2093-8816","authenticated-orcid":false,"given":"Fernanda Mattos de","family":"Souza","sequence":"first","affiliation":[{"name":"Universidade do Estado do Rio de Janeiro,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9733-5098","authenticated-orcid":false,"given":"Ricardo E.","family":"Steffen","sequence":"additional","affiliation":[{"name":"Universidade do Estado do Rio de Janeiro,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7568-5014","authenticated-orcid":false,"given":"M\u00e1rcia Ferreira Teixeira","family":"Pinto","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o Oswaldo Cruz,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8132-6288","authenticated-orcid":false,"given":"Thiago Nascimento do","family":"Prado","sequence":"additional","affiliation":[{"name":"Universidade Federal do Esp\u00edrito Santo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4826-3355","authenticated-orcid":false,"given":"Ethel Leonor Noia","family":"Maciel","sequence":"additional","affiliation":[{"name":"Universidade Federal do Esp\u00edrito Santo,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4000-4984","authenticated-orcid":false,"given":"Anete","family":"Trajman","sequence":"additional","affiliation":[{"name":"McGill University,  Canada; Universidade Federal do Rio de Janeiro,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"key":"ref1","series-title":"Diretrizes metodol\u00f3gicas: diretriz de avalia\u00e7\u00e3o econ\u00f4mica","year":"2014"},{"key":"ref2","series-title":"Resolution adopted by the General Assembly on 10 October 2019."},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1801789","DOI":"10.1183\/13993003.01789-2018","article-title":"Latent tuberculosis infection in health care workers in low and middle-income countries an updated systematic review","volume":"53","author":"Apriani L","year":"2019","journal-title":"Eur Respir J"},{"key":"ref4","series-title":"Protocolo de vigil\u00e2ncia da infec\u00e7\u00e3o latente pelo Mycobacterium tuberculosis no Brasil","year":"2022"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1471-2458-10-28","article-title":"Referrals for positive tuberculin tests in new health care workers and students a retrospective cohort study","volume":"10","author":"Xu Y","year":"2010","journal-title":"BMC Public Health"},{"key":"ref6","series-title":"WHO consolidated guidelines on tuberculosis. Module 1: prevention. Tuberculosis preventive treatment","year":"2021"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"552","DOI":"10.15585\/mmwr.mm6824a4","article-title":"Nationwide shortage of tuberculin skin test antigens: CDC recommendations for patient care and public health practice.","volume":"68","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref8","article-title":"Portaria SCTIE\/MS n\u00ba 50, de 11 de novembro de 2020. Torna p\u00fablica a decis\u00e3o de incorporar o teste de libera\u00e7\u00e3o de interferon-gama (interferon gamma release assay - IGRA) para detec\u00e7\u00e3o de tuberculose latente em pessoas vivendo com HIV, crian\u00e7as em contato com casos de tuberculose ativa e pacientes candidatos a transplante de c\u00e9lulas-tronco.","year":"2020","journal-title":"Di\u00e1rio Oficial da Uni\u00e3o"},{"key":"ref9","series-title":"Nota Informativa n\u00ba 1\/2022-CGDR\/.DCCI\/SVS\/MS","year":"2022"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1007\/s40273-015-0267-x","article-title":"Cost effectiveness of preventive treatment for tuberculosis in special high-risk populations","volume":"33","author":"Diel R","year":"2015","journal-title":"Pharmacoeconomics"},{"key":"ref11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0225197","article-title":"Cost-effectiveness of QuantiFERON-TB Gold In-Tube versus tuberculin skin test for diagnosis and treatment of latent tuberculosis infection in primary health care workers in Brazil","volume":"14","author":"Loureiro RB","year":"2019","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"21823","DOI":"10.1038\/s41598-020-78737-w","article-title":"Cost-effectiveness of newer technologies for the diagnosis of Mycobacterium tuberculosis infection in Brazilian people living with HIV","volume":"10","author":"Steffen RE","year":"2020","journal-title":"Sci Rep"},{"key":"ref13","series-title":"Manual de recomenda\u00e7\u00f5es para o controle da tuberculose no Brasil.","year":"2018","edition":"2nd"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1093\/clinids\/23.5.954","article-title":"How contagious is tuberculosis","volume":"23","author":"Sepkowitz KA","year":"1996","journal-title":"Clin Infect Dis"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1164\/rccm.201208-1422OC","article-title":"Cough aerosols of Mycobacterium tuberculosis predict new infection a household contact study","volume":"187","author":"Jones-L\u00f3pez EC","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"ref16","first-page":"308","article-title":"The evolution of clinical tuberculosis in adolescents","volume":"47","author":"Sutherland I","year":"1966","journal-title":"Tubercle"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.ijmyco.2016.09.017","article-title":"Reactivation or reinfection in adult tuberculosis is that the question?","volume":"5","author":"Cardona PJ","year":"2016","journal-title":"Int J Mycobacteriol"},{"key":"ref18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0164034","article-title":"Prevalence of latent tuberculosis among health care workers in high burden countries a systematic review and meta-analysis","volume":"11","author":"Nasreen S","year":"2016","journal-title":"PLoS One"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/EDE.0b013e31827825f2","article-title":"Number needed to misdiagnose a measure of diagnostic test effectiveness","volume":"24","author":"Habibzadeh F","year":"2013","journal-title":"Epidemiology"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"m549","DOI":"10.1136\/bmj.m549","article-title":"Absolute risk of tuberculosis among untreated populations with a positive tuberculin skin test or interferon-gamma release assay result systematic review and meta-analysis","volume":"368","author":"Campbell JR","year":"2020","journal-title":"BMJ"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/S1473-3099(16)30216-X","article-title":"The cascade of care in diagnosis and treatment of latent tuberculosis infection a systematic review and meta-analysis","volume":"16","author":"Alsdurf H","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1086\/647944","article-title":"4 months of rifampin compared with 9 months of isoniazid for the management of latent tuberculosis infection a meta-analysis and cost-effectiveness study that focuses on compliance and liver toxicity","volume":"49","author":"Ziakas PD","year":"2009","journal-title":"Clin Infect Dis"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1001\/jama.2016.10357","article-title":"Primary care screening and treatment for latent tuberculosis infection in adults evidence report and systematic review for the US Preventive Services Task Force","volume":"316","author":"Kahwati LC","year":"2016","journal-title":"JAMA"},{"issue":"2","key":"ref24","first-page":"CD001363","article-title":"Isoniazid for preventing tuberculosis in non-HIV infected persons","author":"Smieja MJ","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/S1473-3099(21)00261-9","article-title":"The diagnostic performance of novel skin-based in-vivo tests for tuberculosis infection compared with purified protein derivative tuberculin skin tests and blood-based in vitro interferon- release assays: a systematic review and meta-analysis","volume":"22","author":"Krutikov M","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"335","DOI":"10.4103\/ijmy.ijmy_131_20","article-title":"Recombinant tuberculosis allergen (Diaskintest) in tuberculosis diagnostic in Russia (meta-analysis)","volume":"9","author":"Starshinova A","year":"2020","journal-title":"Int J Mycobacteriol"},{"key":"ref27","series-title":"Use of alternative interferon-gamma release assays for the diagnosis of TB infection: WHO policy statement","year":"2022"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/ebch.1962","article-title":"Rifamycins (rifampicin, rifabutin and rifapentine) compared to isoniazid for preventing tuberculosis in HIV-negative people at risk of active TB","volume":"9","author":"Sharma SK","year":"2014","journal-title":"Evid Based Child Health"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1093\/cid\/ciad246","article-title":"A systematic review and meta-analysis of tuberculous preventative therapy adverse events","volume":"77","author":"Melnychuk L","year":"2023","journal-title":"Clin Infect Dis"},{"key":"ref30","first-page":"e1116","article-title":"Comparing the diagnostic performance of qft-plus to other tests of latent tuberculosis infection a systematic review and meta-analysis","volume":"73","author":"Oh CE","year":"2020","journal-title":"Clin Infect Dis"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s40273-020-00937-z","article-title":"Estimating transition probabilities from published evidence a tutorial for decision modelers","volume":"38","author":"Gidwani R","year":"2020","journal-title":"Pharmacoeconomics"},{"key":"ref32","series-title":"T\u00e1buas completas de mortalidade."},{"key":"ref33","series-title":"Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e OPM do SUS."},{"key":"ref34","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0014014","article-title":"Patients' costs and cost-effectiveness of tuberculosis treatment in dots and non-dots facilities in Rio de Janeiro, Brazil","volume":"5","author":"Steffen R","year":"2010","journal-title":"PLoS One"},{"key":"ref35","series-title":"Cota\u00e7\u00f5es e boletins."},{"key":"ref36","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.jval.2019.03.021","article-title":"Adjusting for inflation and currency changes within health economic studies","volume":"22","author":"Turner HC","year":"2019","journal-title":"Value Health"},{"key":"ref37","series-title":"Global drug facility medicines catalog. February 2022.","author":"Partnership ST"},{"key":"ref38","series-title":"O uso de limiares de custo-efetividade","year":"2022"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jval.2021.10.008","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and elaboration: a report of the ISPOR CHEERS II Good Practices Task Force","volume":"25","author":"Husereau D","year":"2022","journal-title":"Value Health"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1186\/s12913-020-05220-7","article-title":"Resource implications of the latent tuberculosis cascade of care a time and motion study in five countries","volume":"20","author":"Alsdurf H","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"ref41","series-title":"WHO operational handbook on tuberculosis. Module 3: diagnosis. Tests for tuberculosis infection","year":"2022"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"177","DOI":"10.7326\/0003-4819-149-3-200808050-00241","article-title":"Systematic review T-cell-based assays for the diagnosis of latent tuberculosis infection: an update","volume":"149","author":"Pai M","year":"2008","journal-title":"Ann Intern Med"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1186\/s12879-017-2810-1","article-title":"Treatment outcomes of MDR-tuberculosis patients in Brazil a retrospective cohort analysis","volume":"17","author":"Bastos ML","year":"2017","journal-title":"BMC Infect Dis"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"e00021","DOI":"10.1128\/CMR.00021-18","article-title":"Incipient and subclinical tuberculosis a clinical review of early stages and progression of infection","volume":"31","author":"Drain PK","year":"2018","journal-title":"Clin Microbiol Rev"},{"key":"ref45","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0102773","article-title":"Comparison of interferon-c release assay to two cut-off points of tuberculin skin test to detect latent Mycobacterium tuberculosis infection in primary health care workers","volume":"9","author":"Souza FM","year":"2014","journal-title":"PLoS One"}],"container-title":["Cadernos de Sa\u00fade P\u00fablica"],"original-title":["Testes cut\u00e2neos baseados em ant\u00edgenos de tuberculose e QFT-Plus para diagn\u00f3stico da infec\u00e7\u00e3o por Mycobacterium tuberculosis em profissionais de sa\u00fade brasileiros: uma an\u00e1lise de custo-efetividade"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0102-311X2025000101410&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T11:48:41Z","timestamp":1740397721000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-311X2025000101410&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"alternative-id":["S0102-311X2025000101410"],"URL":"https:\/\/doi.org\/10.1590\/0102-311xen178623","relation":{},"ISSN":["1678-4464","0102-311X"],"issn-type":[{"value":"1678-4464","type":"electronic"},{"value":"0102-311X","type":"print"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e00178623"}}