Direct Cost of TTT in 2016 from a Healthcare System Perspective

Estimated total cost, in millions of 2016 U.S. Dollars (USD), of targeted testing and treatment for LTBI among five key populations in four states.

Graph Information

This page shows the results of an analysis on the cost of targeted testing and treatment (TTT) of latent tuberculosis infection (LTBI) in California, New York, Florida, and Texas.

The target population in each state consists of 50% of all non-U.S.–born persons in each state, 80% of all persons living with diabetes, and 100% of all persons living with other risk factors, including HIV infection, homelessness and incarceration. Persons living with diabetes include both U.S.–born and non-U.S.–born individuals. The TTT intervention is modeled as being implemented in year one, and epidemiologic impact and costs (including costs averted due to future TB cases averted) are evaluated over a 30-year horizon.

In California, total costs of targeted testing and treatment (TTT) are about $825 million for non-U.S.-born persons and about $386 million for persons with diabetes both non-U.S.–born and U.S.–born, which together account for about 93% of the total costs across all populations in California. Out of the total costs due to interventions, about 63% are costs of testing and 37% are costs of treatment for non-U.S.–born persons, and 76% are costs of testing and 24% are costs of treatment for persons living with diabetes.

You can use the scrollbars along the X and Y axis of the graph to examine the costs of TTT for a certain population in a state or compare costs across states. The data tables on the right-hand side reflect the specific values in the graph in millions of United States dollars for each respective state and population.

Testing costs include the cost of the interferon-gamma release assay (IGRA, modeled as QuantiFERON-TB Gold, QFT: $95) and the cost of the X-ray ($25, for patients with positive IGRA results). Treatment costs include the costs of 3 months of self-administered isoniazid & rifapentine therapy ($417), the cost of a lab test ($40), costs due to toxicity not requiring hospitalization ($207, assumed to occur in 3.2% of all patients initiating LTBI treatment) and costs due to a toxicity with hospitalization ($6,630, assumed to occur in 0.015% of all patients initiating LTBI treatment). We assumed that the diagnostic test for latent TB infection, otherwise known as the IGRA, will correctly diagnose LTBI cases 85% of the time (sensitivity); treatment for LTBI will be initiated 85% of the time; 3 months of self-administered isoniazid & rifapentine therapy will be completed 78% of the time among persons who initiated treatment (assuming 66% net initiation and completion); and 93% efficacy (prevention of future progression to TB disease) among those who complete the therapy. Costs were adjusted for cost of living in each state.