Effectiveness and Cost-Effectiveness of Expanded Targeted Testing and Treatment of Latent Tuberculosis Infection Among the Medicare Population in 2022.

Details

• Alternative Title:
  Annals of Internal Medicine, 2025, v. 178, no. 4: Effectiveness and Cost-Effectiveness of Expanded Targeted Testing and Treatment of Latent Tuberculosis Infection Among the Medicare Population in 2022.
• Journal Article:
  Annals of Internal Medicine
• Personal Author:
  Li, Yunfei ; Marks, Suzanne M. ; Asay, Garrett R. Beeler ; Winston, Carla A. ; Pepin, Dawn ; McClure, Susan ; Swartwood, Nicole A. ; Cohen, Ted ; Horsburgh, C. Robert ; Salomon, Joshua A. ; Menzies, Nicolas A.
• Description:
  In the United States, older adults have elevated prevalence of latent tuberculosis infection (LTBI) and incidence of tuberculosis (TB).
  
  To estimate the health benefits and cost-effectiveness of LTBI testing and treatment among the Medicare-eligible population.
  
  Model-based cost-effectiveness analysis.
  
  Nationally representative surveys and published evidence.
  
  Medicare-eligible persons aged 65 years or older with at least 1 of 15 factors associated with elevated TB risk, as identified by guidelines from the U.S. Preventive Services Task Force (USPSTF) and other organizations.
  
  Lifetime.
  
  Societal.
  
  One-time offer of LTBI testing and treatment versus no intervention.
  
  Lifetime TB cases and deaths averted, quality-adjusted life-years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs).
  
  In 2022, there were an estimated 29.9 million Medicare-eligible persons (95% uncertainty interval UI, 28.4 to 31.6 million persons) aged 65 years or older with elevated TB risks, including 14.7 million (95% UI, 13.4 to 16.0 million) with USPSTF-recommended factors. In the target population, 4.9 million persons (95% UI, 4.0 to 5.8 million persons) (16.4% 95% UI, 13.9% to 19.1%) were estimated to have LTBI. Testing and treatment of LTBI was estimated to prevent 10 946 TB cases (95% UI, 4684 to 20 579 cases) and 2579 TB deaths (95% UI, 1106 to 4882 deaths), with 13 234 lifetime QALYs (95% UI, 5343 to 25 519 lifetime QALYs) gained. For the overall target population and for persons with USPSTF-recommended factors, ICERs were $192 000 (95% UI, $92 000 to $503 000) and $155 000 (95% UI, $77 000 to $393 000) per QALY gained, respectively.
  
  The ICER was $109 000 (95% UI, $49 000 to $285 000) per QALY gained for 65-year-olds newly eligible for Medicare.
  
  Health benefits from averted post-TB sequelae were not estimated.
  
  Medicare-eligible persons represent approximately one third of all U.S. persons with LTBI. Testing and treatment of LTBI in this population could lead to substantial reductions in TB and TB-related mortality, particularly among 65-year-olds newly eligible for Medicare.
  
  Centers for Disease Control and Prevention.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Latent Tuberculosis
  • Cost-Benefit Analysis
  • Medicare
  • Aged
  • Quality-Adjusted Life Years
  • Antitubercular Agents
  • Mass Screening
  • Male
  • Female
  More +
• Source:
  Annals of Internal Medicine, 2025, v. 178, no. 4
• DOI:
  https://doi.org/10.7326/ANNALS-24-00870
• ISSN:
  0003-4819 ; 1539-3704
• Pubmed ID:
  39918348
• Pubmed Central ID:
  PMC11996599
• Document Type:
  Text
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  United States
• Pages in Document:
  479-489 (20 pdf pages)
• Volume:
  178
• Issue:
  4
• Download URL:
  https://stacks.cdc.gov/view/cdc/261697/cdc_261697_DS1.pdf
• File Type:
  [PDF - 791.29 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:ce7119e4f1688872cc19a50315e95a51c08497ecb3370b19eb877fd9ae801acc22b8b2545a05ca93ce6282e3afaa52f49282c850fbdc7075506c26ddfba94df8