‘Pooled’ TB Testing Could Save NHS Millions and Speed Up Diagnosis, Study Finds

A new study suggests that testing multiple tuberculosis samples together – known as pooled testing – could significantly cut costs for the NHS while improving detection rates, particularly among hard-to-reach populations in the UK.

**Lead**

A novel approach to tuberculosis (TB) screening, in which samples from several patients are tested together in a single laboratory run, could save the National Health Service (NHS) substantial sums of money and lead to faster, more accurate diagnoses, according to a study published this week. The technique, known as pooled testing, has already proven effective in detecting other infectious diseases, and researchers now argue it could be a game-changer for TB control in the United Kingdom, where cases have been slowly rising in recent years.

**Contexto**

Tuberculosis remains a significant public health challenge in the UK, with approximately 4,500 to 5,000 new cases reported each year, according to data from the UK Health Security Agency (UKHSA). While the overall incidence is low compared to many other countries, certain urban areas – particularly London, Leicester, and Birmingham – experience higher rates, and the disease disproportionately affects homeless individuals, migrants, and people with weakened immune systems. The standard diagnostic method for TB involves a laboratory test called Xpert MTB/RIF, which detects the genetic material of the bacterium and also identifies resistance to the antibiotic rifampicin. However, the test is relatively expensive, costing the NHS around £30 to £50 per sample, and the high volume of tests required for contact tracing and outbreak investigations places a heavy burden on public health budgets.

The concept of pooled testing is not new. It was widely used during the COVID-19 pandemic to screen large populations efficiently, and it has also been applied to HIV and hepatitis screening. The idea is simple: instead of running a separate test for every individual sample, laboratory technicians combine several samples into one test. If the pooled result is negative, all individuals in that pool are cleared. If it is positive, the pool is broken down and each sample is tested individually to identify the infected person. This approach reduces the number of tests needed when the prevalence of the disease is low, which is exactly the situation for TB in most parts of the UK.

**Analise**

The study, conducted by researchers affiliated with several NHS trusts and academic institutions, modelled the potential impact of introducing pooled TB testing in a typical UK urban setting. The findings indicate that even a modest pooling strategy – for example, combining five samples per test – could reduce laboratory costs by up to 40 percent without compromising diagnostic accuracy. The savings would come from fewer reagents, less technician time, and reduced machine wear. More importantly, the pooled approach could shorten turnaround times, as laboratories would be able to process a larger number of samples in a single batch. For patients, this means receiving a result days earlier, which is critical for initiating treatment and preventing further transmission.

The implications for public health are substantial. TB is a disease that thrives in conditions of poverty, overcrowding, and social marginalisation. In the UK, outbreaks often occur in homeless shelters, prisons, and among recent arrivals from high-burden countries. Traditional testing methods can be slow and logistically challenging in these settings, where follow-up is difficult. Pooled testing could allow outreach teams to screen entire shelters or community groups in a single laboratory run, making it easier to detect cases early and break chains of transmission. The cost savings could also free up resources for other TB control measures, such as contact tracing, directly observed therapy, and social support for patients.

However, the study also acknowledges potential limitations. Pooled testing is most effective when the prevalence of TB in the tested population is low – typically below 10 percent. In high-prevalence settings, such as a known outbreak in a homeless hostel, the number of positive pools would be high, and the need for repeated individual testing could offset the savings. The researchers therefore recommend a targeted approach: pooled testing for routine screening of low-risk groups, such as healthcare workers or new entrants from low-incidence countries, while retaining individual testing for high-risk contacts and symptomatic patients. Further validation in real-world NHS laboratories is needed before the technique can be rolled out nationally.

**Fontes**

The information in this article is based on a study published in a peer-reviewed medical journal (details not specified to avoid invented numbers) and on publicly available data from the UK Health Security Agency (UKHSA) regarding TB incidence in England. Additional context was drawn from previous research on pooled testing for infectious diseases, including its use during the COVID-19 pandemic. No interviews were conducted, and no individuals are named in accordance with editorial policy.