Optimizing tuberculosis infection screening strategies for people living with HIV in Thailand: a cost-effectiveness analysis

To support evidence-based decision-making in Thailand, we assessed the cost-effectiveness of QuantiFERON-TB Gold Plus (QFT-Plus) compared to the Tuberculin Skin Test (TST) in people living with HIV (PLWH). The outcomes of this investigation are intended to provide valuable guidance for policymakers in Thailand and other low- and middle-income countries (LMICs) to choose the most appropriate screening tests to detect tuberculosis infection (TBI). We evaluated QFT-Plus versus the TST using a decision-tree–Markov model under a healthcare payer perspective, expressed in 2022 US dollars. Costs and quality-adjusted life-years (QALYs) were discounted at 3% per year. The model simulated one-time screening at baseline for a hypothetical cohort of adults living with HIV in Thailand (mean age 38 years), followed over a lifetime horizon to capture downstream costs and health effects of preventing active tuberculosis (TB). Inputs were drawn from Thai national sources, World Health Organization (WHO) guidance, and published literature. Outcomes were reported per individual screened and treated. QFT-Plus reduced lifetime risk of active TB by ~ 41% versus TST and yielded lower lifetime costs per individual screened and treated ($74.99 vs. $77.11). Deterministic and probabilistic sensitivity analyses confirmed robustness; QFT-Plus was cost-effective in 100% of simulations across willingness-to-pay thresholds. For PLWH in Thailand, QFT-plus was cost-effective when compared to TST. These findings support prioritizing QFT-plus in national screening guidelines and resource allocation decisions in similar high-burden, resource-limited settings. Further prospective cohort studies should be conducted in similar settings to validate and generalize these results.