OBJECTIVES: Latent tuberculosis infection (LTBI) has a high global prevalence and can progress to its active form in immunocompromised patients. There is also considerable uncertainty about diagnostic tests accuracy because there is no gold standard. The purpose was to evaluate the accuracy of the interferon gamma release test (IGRA) to detect LTBI and predict the active tuberculosis in solid organ transplant candidates (1st group) and patients with immune-mediated inflammatory diseases (2nd group).

METHODS: To assess the incorporation of IGRA in the Brazilian Health System, a systematic review with economic evaluation was conducted.

RESULTS: In the first group, the sensitivity of the IGRA was 58% higher than the tuberculin skin test PT 5mm 46%, and the specificity was 89% higher than the PT 5mm 86%. IGRA sensitivity ranged from 0.11 to 0.50 in the second group of patients. In transplanted patients, the progression to active tuberculosis was slower and similar across tests. The population of the second group had the highest percentages of evolution to active tuberculosis, ranging from 4.25 to 13.2%. In the economic evaluation, the IGRA ICER was BRL 8,340.68 for each case of tuberculosis avoided in patients in the 2nd group and the incremental budgetary impact (IOI) in 5 years was BRL 40,527,273.25. As for the patients in the 1st group, the ICER was BRL 48,905.00 with the IOI of BRL 1,131,654.58.

CONCLUSIONS: The studies were not able to identify the most accurate test to detect LTBI and to prevent active TB progression. The incorporation of IGRA in Brazilian Healthcare System as an alternative diagnostic test to LTBI could become a strategic decision in the face of a possible shortage of tuberculin test and would be the best choice for individuals vaccinated with BCG.