Cost-effectiveness of expanded latent TB infection testing and treatment: Lynn City, Massachusetts, USA

Type: Journal Article
Date: January 2024

Citation

G R Beeler AsayR WoodruffD M SandersonC F FisherS M Marks, V D GreenA M TibbsA N HillH H HaptuD McManusR K ParadiseC Auguste-NelsonJ J Cochran. “Cost effectiveness of expanded latent TB infection testing and treatment: Lynn City, Massachusetts, USA”. The International Journal of Tuberculosis and Lung Disease (January 2024). 

Abstract

Between October 2016 and March 2019, Lynn Community Health Center in Massachusetts implemented a targeted latent TB infection testing and treatment (TTT) program, increasing testing from a baseline of 1,200 patients tested to an average of 3,531 patients tested, or 9% of the population per year.

METHODS: We compared pre-implementation TTT, represented by the first two quarters of implementation data, to TTT, represented by 12 quarters of data. Time, diagnostic, and laboratory resources were estimated using micro-costing. Other cost and testing data were obtained from the electronic health record, pharmaceutical claims, and published reimbursement rates. A Markov cohort model estimated future health outcomes and cost-effectiveness from a societal perspective in 2020 US dollars. Monte Carlo simulation generated 95% uncertainty intervals.

RESULTS: The TTT program exhibited extended dominance over baseline pre-intervention testing and had an incremental cost-effectiveness ratio (ICER) of US$52,603 (US$22,008-US$95,360). When compared to baseline pre-TTT testing, the TTT program averted an estimated additional 7.12 TB cases, 3.49 hospitalizations, and 0.16 deaths per lifetime cohort each year.

CONCLUSIONS: TTT was more cost-effective than baseline pre-implementation testing. Lynn Community Health Centers experience can help inform other clinics considering expanding latent TB infection testing.