Estimating tuberculosis cases and their economic costs averted in the United States over the past two decades

Castro, Kenneth G.; Marks, Suzanne M.; Chen, M.P.; Hill, Andrew; Becerra, José E.; Miramontes, Roque; Winston, Carla A.; Navin, Thomas R.; Pratt, Robert; Young, K.; LoBue, Philip

doi:10.5588/ijtld.15.1001

Cited by 25 publications

(22 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Countries developing a national plan in support of the global TB elimination goal should consider the successes and challenges the US has experienced in nearly three decades since the US TB elimination plan was first proposed in 1989 . TB has reached historic lows in the US through great efforts towards detecting and treating active disease, preventing transmission in healthcare facilities and congregate settings and treating LTBI in close contacts and PLWH, resulting in estimated societal savings of $6.7–$14.5 billion . Treatment of LTBI among recent immigrants and refugees was largely limited to those with radiological evidence of inactive TB, and the impact of those efforts appear to have plateaued with TB rates stagnated in recent years at 30 per million .…”

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

Latent tuberculosis infection: Opportunities and challenges

et al. 2018

View full text Add to dashboard Cite

Diagnosing and treating latent tuberculosis (TB) infection (LTBI) is recognized by the World Health Organization as an important strategy to accelerate the decline in global TB and achieve TB elimination. Even among low-TB burden countries that have achieved high rates of detection and successful treatment for active TB, a number of barriers have prevented implementing or expanding LTBI treatment programmes. Of those infected with TB, relatively few will develop active disease and the current diagnostic tests have a low predictive value. LTBI treatment using isoniazid (INH) has low completion rates due to the long duration of therapy and poor tolerability. Both patients and physicians often perceive the risk of toxicity to be greater than the risk of reactivation TB. As a result, LTBI treatment has had a limited or negligible role outside of countries with high resources and low burden of disease. New tools have emerged including the interferon-gamma release assays that more accurately diagnose LTBI, particularly in people vaccinated with Bacillus Calmette-Guerin (BCG). Shorter, better tolerated treatment using rifamycins are proving safe and effective alternatives to INH. While still imperfect, TB prevention using these new diagnostic and treatment tools appear cost effective in modelling studies in the United States and have the potential to improve TB prevention efforts globally. Continued research to understand the host-organism interactions within the spectrum of LTBI is needed to develop better tools. Until then, overcoming the barriers and optimizing our current tools is essential for progressing toward TB elimination.

show abstract

Section: The Challenge Of Implementing National Tb Elimination Plansmentioning

confidence: 99%

Latent tuberculosis infection: Opportunities and challenges

et al. 2018

View full text Add to dashboard Cite

show abstract

“…To assess incremental cost-effectiveness of individual regimens, we applied the regimen-specific completion and adverse effects discontinuation averages from our review, MDR-TB societal costs (excluding deaths) [10, 11] in 2014 US dollars [12], along with efficacy estimates from mouse models [6] and LTBI treatment costs (updated to 2014 dollars) used by Holland et al [9] to conduct a decision analysis (Supplementary Appendix) from the societal perspective of a hypothetical cohort of 100 MDR-TB cases and their contacts per year for 40 years. We also used the following quality-adjusted life year (QALY) estimates: [13] 0.53 alive after MDR-TB, 0.90 alive with MDR-LTBI, 0.80 alive with MDR LTBI post–adverse effect treatment stop, and 0.75 alive with MDR-LTBI posthospitalization for adverse effect treatment stop.…”

Section: Methodsmentioning

confidence: 99%

Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Marks

Mase

Morris

2017

Clinical Infectious Diseases

101

View full text Add to dashboard Cite

Background Evidence-based recommendations for treating persons having presumed latent tuberculosis (LTBI) after contact to infectious multidrug-resistant (MDR) tuberculosis (TB) are lacking because published data consist of small observational studies. Tuberculosis incidence in persons treated for latent MDR -TB infection is unknown. Methods We conducted a systematic review of studies published 1 January 1994–31 December 2014 to analyze TB incidence, treatment completion and discontinuation, and cost-effectiveness. We considered contacts with LTBI effectively treated if they were on ≥1 medication to which their MDR-TB strain was likely susceptible. We selected studies that compared treatment vs nontreatment outcomes and performed a meta-analysis to estimate the relative risk of TB incidence and its 95% confidence interval. Results We abstracted data from 21 articles that met inclusion criteria. Six articles presented outcomes for contacts who were treated compared with those not treated for MDR-LTBI; 10 presented outcomes only for treated contacts, and 5 presented outcomes only for untreated contacts. The estimated MDR-TB incidence reduction was 90% (9%–99%) using data from 5 comparison studies. We also found high treatment discontinuation rates due to adverse effects in persons taking pyrazinamide-containing regimens. Cost-effectiveness was greatest using a fluoroquinolone/ethambutol combination regimen. Conclusions Few studies met inclusion criteria, therefore results should be cautiously interpreted. We found a reduced risk of TB incidence with treatment for MDR-LTBI, suggesting effectiveness in prevention of progression to MDR-TB, and confirmed cost-effectiveness. However, we found that pyrazinamide-containing MDR-LTBI regimens often resulted in treatment discontinuation due to adverse effects.

show abstract

“…Triangulating these estimates with data from the REMEDY registry, RHD was estimated to cost US$ 3900 per patient per year in total, with most of the total cost being driven by surgical theatre and cardiac catheterization laboratory costs. These costs are much higher than the annual cost of the facility-level care delivery of HIV/AIDS, drug sensitive tuberculosis, and hypertension, which have been estimated at around US$ 660 (in 2016) [20], US$ 250 (in 2015) [21], and US$ 260 (in 2016) [22] per year, respectively.…”

Section: Discussionmentioning

confidence: 99%

Health System Costs of Rheumatic Heart Disease Care in South Africa

Hellebo

Zühlke

Watkins

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundRheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries, including South Africa. Lack of adequate evidence regarding the cost of RHD care has hindered national and international actions to prevent RHD related deaths. The objective of this study was to estimate the cost of RHD-related health services in a tertiary hospital in the Western Cape, South Africa. MethodsThe primary data on service utilization were collected from a randomly selected sample of 100 patient medical records from the Global Rheumatic Heart Disease Registry (the REMEDY study), a registry of individuals living with RHD. Patient-level clinical data, including, prices and quantities of medications and laboratory tests, were collected from the main tertiary hospital providing RHD care. All annual costs from health system perspective were estimated in 2017 (base year) South African Rand (ZAR) using a combination of ingredients and step-down costing approaches and later converted to United States dollars (US$). Step-down costing was used to estimate provider time costs and all other facility costs such as overheads. 3% discount rate was also employed in order to allow depreciation and opportunity cost. We aggregated data to estimate the total annual costs and the average annual per-patient cost of RHD and conducted a one-way sensitivity analysis. ResultsThe estimated total cost of RHD care at the tertiary hospital was US$ 2 million (in 2017 US$) for the year 2017, with surgery costs accounting for 65%. Per-patient average annual costs were US$ 3900. For the subset of costs estimated using the ingredients approach, outpatient medications, and consumables related to cardiac catheterization and heart valve surgery were the main cost drivers. ConclusionsRHD-related healthcare consumes significant tertiary hospital resources in South Africa, with annual per-patient costs higher than many other non-communicable and infectious diseases. This analysis supports the scaling up of primary and secondary prevention programs at primary health centers in order to reduce future tertiary care costs. The study could also inform resource allocation efforts and provide cost estimates for future studies of intervention cost-effectiveness.

show abstract

Estimating tuberculosis cases and their economic costs averted in the United States over the past two decades

Cited by 25 publications

References 17 publications

Latent tuberculosis infection: Opportunities and challenges

Latent tuberculosis infection: Opportunities and challenges

Systematic Review, Meta-analysis, and Cost-effectiveness of Treatment of Latent Tuberculosis to Reduce Progression to Multidrug-Resistant Tuberculosis

Health System Costs of Rheumatic Heart Disease Care in South Africa

Contact Info

Product

Resources

About