The Societal Cost of Tuberculosis: Tarrant County, Texas, 2002

School of Public Health, University of North Texas Health Science Center at Fort Worth, Ft. Worth, TX 76107, USA.
Annals of epidemiology (Impact Factor: 2). 01/2010; 20(1):1-7. DOI: 10.1016/j.annepidem.2009.09.004
Source: PubMed


Cost analyses of tuberculosis (TB) in the United States have not included elements that may be prevented if TB were prevented, such as losses associated with TB-related disability, personal and other costs to society. Unmeasured TB costs lead to underestimates of the benefit of prevention and create conditions that could result in a resurgence of TB. We gathered data from Tarrant County, Texas, for 2002, to estimate the societal cost due to TB.
We estimated societal costs due to the presence or suspicion of TB using known variable and fixed costs incurred to all parties. These include costs for infrastructure; diagnostics and surveillance; inpatient and outpatient treatment of active, suspected, and latent TB infection (LTBI); epidemiologic activities; personal costs borne by patients and by others for lost time, disability, and death; and the cost of secondary transmission. A discount rate of 3% was used.
During 2002, 108 TB cases were confirmed in Tarrant County, costing an estimated $40,574,953. The average societal cost per TB illness was $ 376,255. Secondary transmission created 47% and pulmonary impairment after TB created 35.4% of the total societal cost per illness.
Prior estimates have concluded that treatment costs constitute most (86%) TB-related expenditures. From a societal perspective treatment and other direct costs account for little (3.3%) of the full burden. These data predict that preventing infection through earlier TB diagnosis and treatment of LTBI and expanding treatment of LTBI may be the most feasible strategies to reduce the cost of TB.

Download full-text


Available from: Stephen E Weis
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clin Microbiol Infect 2010; 16: 1713–1720 Healthcare providers continue to seek improved methods for preventing, detecting and treating diseases that affect human survival and quality of life. At the same time, there will always be financial constraints because of limited societal resources. Many of the discussions on how to provide economically sound solutions to this challenge have not fully engaged the input of clinicians in the field. The purpose of this review is to increase economic knowledge for clinicians. We cover healthcare cost elements and methods used to assign value to a health outcome. We outline the challenges in conducting economic studies in the field of infectious diseases. Finally, we discuss the meaning of efficiency from multiple perspectives, and how the concept of economic externalities applies to infectious diseases.
    Full-text · Article · Dec 2010 · Clinical Microbiology and Infection
  • [Show abstract] [Hide abstract]
    ABSTRACT: This panel-data study concerns the incidence of newly diagnosed tuberculosis (TB) in specific U.S. metropolitan areas among immigrants and, in turn, the possible transmission of the disease to the native-born population of these same metropolitan areas. The study includes 50 U.S. Metropolitan Statistical Areas as annual observations, 1993–2007. We find that a 10% increase in the number of high-incidence immigrants results in a 2.87% increase in TB among the foreign-born population, and that a 10% increase in the number of foreign-born TB cases increases the number of new TB cases among the native-born by 1.11%. The study concludes with a benefit/cost analysis of the societal cost of TB and suggests that testing all immigrants for TB would be a cost-effective method to limit the amount of TB that enters U.S. from abroad, thus limiting the transmission to both the foreign- and native-born populations.
    No preview · Article · Dec 2011 · Population Research and Policy Review
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Disparities in outcomes associated with race and ethnicity are well documented for many diseases and patient populations. Tuberculosis (TB) disproportionately affects economically disadvantaged, racial and ethnic minority populations. Pulmonary impairment after tuberculosis (PIAT) contributes heavily to the societal burden of TB. Individual impacts associated with PIAT may vary by race/ethnicity or socioeconomic status. We analyzed the pulmonary function of 320 prospectively identified patients with pulmonary tuberculosis who had completed at least 20 weeks standard anti-TB regimes by directly observed therapy. We compared frequency and severity of spirometry-defined PIAT in groups stratified by demographics, pulmonary risk factors, and race/ethnicity, and examined clinical correlates to pulmonary function deficits. Pulmonary impairment after tuberculosis was identified in 71% of non-Hispanic Whites, 58% of non-Hispanic Blacks, 49% of Asians and 32% of Hispanics (p < 0.001). Predictors for PIAT varied between race/ethnicity. PIAT was evenly distributed across all levels of socioeconomic status suggesting that PIAT and socioeconomic status are not related. PIAT and its severity were significantly associated with abnormal chest x-ray, p < 0.0001. There was no association between race/ethnicity and time to beginning TB treatment, p = 0.978. Despite controlling for cigarette smoking, socioeconomic status and time to beginning TB treatment, non-Hispanic White race/ethnicity remained an independent predictor for disproportionately frequent and severe pulmonary impairment after tuberculosis relative to other race/ethnic groups. Since race/ethnicity was self reported and that race is not a biological construct: these findings must be interpreted with caution. However, because race/ethnicity is a proxy for several other unmeasured host, pathogen or environment factors that may contribute to disparate health outcomes, these results are meant to suggest hypotheses for further research.
    Full-text · Article · Feb 2012 · BMC Public Health
Show more