COST-EFFECTIVENESS OF LATENT TUBERCULOSIS INFECTION INTERVENTIONS IMPLEMENTED DURING THE TUBERCULOSIS EPIDEMIOLOGIC STUDIES CONSORTIUM (TBESC-III)
Author(s)
Carolina Barbosa1, Nicolas Menzies, PhD2, Stephen Orme, MA3, Hening Cui, MSc2, Kristen Henretty, MSc4, Kathryn Winglee, PhD5, Laura Vonnahme, PhD5, Julie Espey, MPH5, Garrett R. Beeler Asay, PhD5, Preeti Ravindhran, MPH5.
1Research Health Economist, Chicago, IL, USA, 2Harvard University, Boston, MA, USA, 3RTI International, Sugar Land, TX, USA, 4RTI International, RTP, NC, USA, 5Centers for Disease Control and Prevention, Atlanta, GA, USA.
1Research Health Economist, Chicago, IL, USA, 2Harvard University, Boston, MA, USA, 3RTI International, Sugar Land, TX, USA, 4RTI International, RTP, NC, USA, 5Centers for Disease Control and Prevention, Atlanta, GA, USA.
OBJECTIVES: About 5%-10% of people who acquire latent tuberculosis (TB) infection (LTBI) will develop TB. LTBI is a barrier to eliminating TB in the United States. The Centers for Disease Control and Prevention launched the Tuberculosis Epidemiologic Studies Consortium (TBESC) III in 2021 to advance U.S. TB elimination efforts by improving LTBI targeted testing and treatment (TTT) in higher-risk non-U.S.-born populations in primary care settings. We estimated the health and economic impacts of TTT interventions implemented during TBESC-III in three primary care clinical networks.
METHODS: We adapted a validated compartmental model of TB in the United States to three primary care sites. The model simulates the impact of interventions to improve LTBI TTT on long-term individual health benefits and population health benefits from averted secondary infections and TB cases. We parameterized the model using data on utilization and costs from 8 TTT interventions across 3 sites. The model simulated pre-existing TTT approaches (status-quo), enhanced TTT interventions to increase uptake and completion, and a ‘no TTT’ counterfactual. Outcomes included TB cases, TB deaths, quality-adjusted life years (QALYs), incremental health system costs, and incremental cost-effectiveness ratios (ICERs).
RESULTS: In preliminary analyses, compared to the counterfactual of no TTT, the status-quo was projected to prevent 1.44-6.78 TB cases and 0.17-1.03 TB deaths with 1.50-9.26 QALYs gained per 10,000 persons. Enhanced TTT interventions were estimated to avert an additional 5-17% and 4-17% of TB cases and deaths, respectively, with 5-18% greater QALYs gained. Compared to the status quo, enhanced TTT had ICERs ranging from $3,403 to $2,628,725/ QALY. ICERs were lower in settings with higher LTBI prevalence, and lower health service unit costs.
CONCLUSIONS: Enhanced LTBI targeted testing and treatment interventions within primary care settings can reduce TB-associated morbidity, improve health, and are potentially cost-effective.
METHODS: We adapted a validated compartmental model of TB in the United States to three primary care sites. The model simulates the impact of interventions to improve LTBI TTT on long-term individual health benefits and population health benefits from averted secondary infections and TB cases. We parameterized the model using data on utilization and costs from 8 TTT interventions across 3 sites. The model simulated pre-existing TTT approaches (status-quo), enhanced TTT interventions to increase uptake and completion, and a ‘no TTT’ counterfactual. Outcomes included TB cases, TB deaths, quality-adjusted life years (QALYs), incremental health system costs, and incremental cost-effectiveness ratios (ICERs).
RESULTS: In preliminary analyses, compared to the counterfactual of no TTT, the status-quo was projected to prevent 1.44-6.78 TB cases and 0.17-1.03 TB deaths with 1.50-9.26 QALYs gained per 10,000 persons. Enhanced TTT interventions were estimated to avert an additional 5-17% and 4-17% of TB cases and deaths, respectively, with 5-18% greater QALYs gained. Compared to the status quo, enhanced TTT had ICERs ranging from $3,403 to $2,628,725/ QALY. ICERs were lower in settings with higher LTBI prevalence, and lower health service unit costs.
CONCLUSIONS: Enhanced LTBI targeted testing and treatment interventions within primary care settings can reduce TB-associated morbidity, improve health, and are potentially cost-effective.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE121
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine)