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WHAT IS THE MAGNITUDE AND COST BURDEN OF SUSPECTED TUBERCULOSIS?

University of North Texas Health Science Center at Fort Worth, Fort Worth, TX

PURPOSE: There is little or no information in the literature regarding the numbers of patients who are suspected of but subsequently ruled out for TB infection before meeting reporting requirements. These patients represent an unmeasured cost of TB to the healthcare system. Without fully quantifying the burden of TB on U.S. healthcare, public TB prevention and control efforts are undervalued when considered on the basis of relative cost and benefits. This leads to reduced public and political support and resurgence of disease. We estimated the number of patients with suspected TB who are never reported using acid-fast bacillus (AFB) cultures completed as a proxy. Quantifying suspected tuberculosis in the community healthcare setting is one component of measuring the burden created by TB.

METHODS: We collected data on the number of AFB tests conducted in all hospitals in Tarrant County, Texas in calendar year 2002. Outcome measures were total number of AFBs, estimated cost incurred by testing, and number of individuals affected. Cost data is taken from the Texas Department of Health. The unit of analysis was the program and no patient identifiers or individual information was collected.

RESULTS: In Tarrant County, Texas hospitals 5,768 AFB cultures were completed in 1,920 patients over one calendar year. 181 of these cultures were positive for any AFB growth, and 43 were positive for M. tb. Each AFB culture completed cost approximately $96, creating a cost of $12,877 to confirm M. tb.

CONCLUSION: The suspicion of tuberculosis for many respiratory diseases incurs significant, previously unmeasured cost to the U.S. healthcare system. Over 134 AFB cultures are completed at a cost of $12,877 to confirm one tuberculosis case in our survey. It is vital to measure the full impact of tuberculosis on the healthcare system to accurately describe the value of elimination and control efforts.

CLINICAL IMPLICATIONS: Use of AFB culture to rule out tuberculosis in low-probability suspects is resource intensive and may be cost-inefficient.

DISCLOSURE: Thaddeus Miller, None.