The practice of latent TB infection (LTBI)-targeted screening using IGRAs is becoming more common, particularly for BCG-vaccinated immigrants living in low-burden settings where laboratory facilities are usually available and the government, medical plans, or research programs cover the cost of testing. However, if, in the real world of high-burden settings, the cost of screening with TST is high, then screening with IGRA is a luxury. Many IGRA research studies performed in high-burden settings frequently have to rely on the sponsor for total or partial funding, as was likely the case in many studies cited in this meta-analysis. Lowering the cost of IGRAs would encourage use by TB programs where they are more needed, identifying more BCG-vaccinated individuals with true infection and candidates for preventive treatment. In conclusion, further research is needed in BCG-unvaccinated close contacts of smear-positive patients to clearly establish similarities or differences in the PPV and NPV between IGRAs and TST, to determine whether there is any difference in the number of individuals identified for preventive treatment using each test, and to establish what the best cost-benefit is in this population.