How much does latent TB testing and treatment cost in England?

Tuberculosis remains a public health concern in England, and the country’s Tuberculosis Action Plan has pushed for more testing of groups at high risk. That increased testing is happening, but planners and policymakers lack detailed health service cost information needed to judge whether screening and treatment programs give good value for money. To fill that gap, a team led by Peter J White surveyed secondary care clinics that carry out large volumes of latent TB infection (LTBI) work. The clinics surveyed were in the London, West Midlands, South East & South West, and North West England TB Control Board areas, together accounting for roughly three-quarters of England’s TB diagnoses. Using interviews and pathway mapping, the researchers recorded how patients move through services and measured the time, tests, and drugs used at each step. From that groundwork they calculated per-patient costs for different testing outcomes and for a range of treatment regimens and monitoring needs. The result is a set of concrete numbers that health services can use to more realistically estimate the cost of LTBI programs.

The clinics in the survey use interferon gamma release assays (IGRAs) (Quantiferon-TB Gold Plus, T-SPOT.TB, or both) to test for LTBI. The researchers report the most common testing outcomes and their costs. For asymptomatic patients, a negative IGRA pathway costs £64.11 per patient (range: £49.08-£81.02), while an asymptomatic positive result costs £142.86 (£120.95-£174.68). Symptomatic patients incur higher costs even when testing negative or positive, at £124.35 (£101.29-£138.23). When those figures are combined into an overall estimate, the cost per patient diagnosed with LTBI is £458.32 (£362.49-£571.47). Treatment costs vary by regimen and how much clinical monitoring is required: 3 months daily Isoniazid and Rifampicin costs £192.68 (£140.43-£255.32) for most patients and £238.62 (£157.47-£346.03) for patients needing more monitoring. Six months daily Isoniazid costs £411.04 (£362.56-£474.25). Four months daily Rifampicin costs £226.97 (£190.15-£270.73). One clinic reported using 3 months of weekly Isoniazid and Rifapentine for some patients, at a cost of £559.05.

These findings matter because they are the first detailed micro-costing estimates for LTBI screening and treatment in England’s secondary care. By breaking down costs into staff time, testing, and drugs, the study provides the granular data needed to assess cost-effectiveness more accurately. That allows local and national services to compare the financial implications of different regimens — for example balancing shorter courses like 3 months daily Isoniazid and Rifampicin or 4 months daily Rifampicin against longer courses such as 6 months daily Isoniazid — and to account for how extra monitoring raises costs. The results should help health planners allocate resources where they are most efficient, guide decisions about which clinics and tests to expand, and inform future economic modelling of the Tuberculosis Action Plan. In short, the numbers give decision-makers a clearer financial picture when weighing the benefits of expanded LTBI testing and treatment against the costs involved.