Public Health Expenditures and Clinical and Social Complexity of Tuberculosis Cases–Alameda County, California, July-December 2017

Abstract

Context: Alameda County, California, is a high tuberculosis (TB) burden county that reported a TB incidence rate of 8.1 per 100 000 during 2017. It is the only high TB burden California county that does not have a public health-funded TB clinic. Objective: To describe TB public health expenditures and clinical and social complexities of TB case-patients. Design, Setting, and Participants: Public health surveillance of confirmed and possible TB case-patients reported to Alameda County Public Health Department during July 1, 2017, to December 31, 2017. Social complexity status was categorized for all case-patients using surveillance data; clinical complexity status, either by surveillance definition or by the Charlson Comorbidity Index (CCI), was categorized only for confirmed TB case-patients. Main Outcome Measures: Total public health and per patient expenditures were stratified by insurance status. Cohen's kappa assessed concordance between clinical complexity definitions. All comparisons were conducted using Fisher's exact or Kruskal-Wallis tests. Results: Of 81 case-patients reported, 68 (84%) had confirmed TB, 29 (36%) were socially complex, and 15 (19%) were uninsured. Total public health expenditures were $487 194, and 18% of expenditures were in nonlabor domains, 57% of which were for TB treatment, diagnostics, and insurance, with insured patients also incurring such expenditures. Median per patient expenditures were significantly higher for uninsured and government-insured patients than for privately insured patients ($7007 and $5045 vs $3704; P = .03). Among confirmed TB case-patients, 72% were clinically complex by surveillance definition and 53% by the CCI; concordance between definitions was poor (κ = 0.25; 95% confidence interval, 0.03-0.46). Conclusions: Total public health expenditures approached $500 000. Most case-patients were clinically complex, and about 20% were uninsured. While expenditures were higher for uninsured case-patients, insured case-patients still incurred TB treatment, diagnostic, and insurance-related expenditures. State and local health departments may be able to use our expenditure estimates by insurance status and description of clinically complex TB case-patients to inform efforts to allocate and secure adequate funding.

Epidemiology of Culture-Negative Pulmonary Tuberculosis—Alameda County, 2010-2019

“…Alameda County is the only high TB burden California County without a public health–funded TB clinic that would generally conduct TB prevention activities, such as screening and treatment of latent TB infection (LTBI) and TB among new immigrants and contacts to infectious PTB cases. Instead, the TB Section partners with community physicians and health centers to promote screening activities, guide evaluation and treatment of LTBI among contacts, and provide oversight for the treatment of TB disease 11,12. With limited resources, directly observed therapy (DOT) is prioritized according to California Department of Public Health (CDPH) criteria for high-risk individuals 13…”

“…Instead, the TB Section partners with community physicians and health centers to promote screening activities, guide evaluation and treatment of LTBI among contacts, and provide oversight for the treatment of TB disease. 11,12 With limited resources, directly observed therapy (DOT) is prioritized according to California Department of Public Health (CDPH) criteria for high-risk individuals. 13…”