Model-Based Cost-Effectiveness of State-level Latent Tuberculosis Interventions in California, Florida, New York and Texas

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Jo, Youngji ; Shrestha, Sourya ; Gomes, Isabella ; Marks, Suzanne ; Hill, Andrew ; Asay, Garrett ; Dowdy, David
• Description:
  Background:
  
  Targeted testing and treatment (TTT) for latent tuberculosis infection (LTBI) is a recommended strategy to accelerate TB reductions and further tuberculosis elimination in the United States (US). Evidence on cost-effectiveness of TTT for key populations can help advance this goal.
  
  Methods:
  
  We used a model of TB transmission to estimate the numbers of individuals who could be tested by interferon-γ release assay (IGRA) and treated for LTBI with three months of self-administered rifapentine and isoniazid (3HP) under various TTT scenarios. Specifically, we considered rapidly scaling up TTT among people who are non-US-born, diabetic, HIV-positive, homeless or incarcerated in California, Florida, New York, and Texas – states where more than half of US TB cases occur. We projected costs (from the healthcare system perspective, in 2018 dollars), thirty-year reductions in TB incidence, and incremental cost effectiveness (cost per quality-adjusted life year [QALY] gained) for TTT in each modeled population.
  
  Results:
  
  The projected cost effectiveness of TTT differed substantially by state and population, while the health impact (number of TB cases averted) was consistently greatest among the non-US-born. TTT was most cost-effective among persons living with HIV (from $2,828/QALY gained in Florida to $11,265/QALY gained in New York) and least cost-effective among people with diabetes (from $223,041/QALY gained in California to $817,753 /QALY in New York).
  
  Conclusions:
  
  The modeled cost-effectiveness of TTT for LTBI varies across states but was consistently greatest among people living with HIV, moderate among people who are non-US-born, incarcerated, or homeless, and least cost-effective among people living with diabetes.
  
  
• Subjects:
  Cost-Benefit Analysis Humans Latent Tuberculosis
• Keywords:
  Cost Effectiveness Latent Tuberculosis Targeting TB Preventive Therapy United States
• Source:
  Clin Infect Dis. 73(9):e3476-e3482
• Pubmed ID:
  32584968
• Pubmed Central ID:
  PMC8077726
• Document Type:
  Journal Article
• Funding:
  National Center for HIV/AIDS, Viral Hepatitis, STD/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; U38 PS004646/PS/NCHHSTP CDC HHSUnited States/ ; CC/CDC HHSUnited States/
• Place as Subject:
  California ; Florida ; New York ; Texas ; United States
• Volume:
  73
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:fe8eb11726438b2440f625a6bbed29319972d928e054b6eb38a473eeb7695aa0
• Download URL:
  https://stacks.cdc.gov/view/cdc/106261/cdc_106261_DS1.pdf
• File Type:
  [PDF - 737.61 KB ]