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Ruth E. Brown, MS; Bess Miller, MD, MSc; William R. Taylor, MD, MPH; Cynthia Palmer, MS; Lynn Bosco, MD, MPH; Ray M. Nicola, MD, MHSA; Jerry Zelinger, MD; Kit Simpson, DrPH

Arch Intern Med. 1995;155(15):1595-1600.

Abstract
Background
The resurgence of tuberculosis (TB) and the increase in multidrug-resistant TB prompted this study, which estimates direct expenditures for TB treatment and public health activities in the United States.

Methods
This retrospective cost of illness study estimated 1991 direct expenditures for TB-related outpatient and inpatient diagnosis and treatment, screening, preventive therapy, contact investigations, surveillance, and outbreak investigations. Existing databases at the Centers for Disease Control and Prevention (Atlanta, Ga) and the Codman Research Group, Lebanon, NH, were supplemented by surveys of state and local TB programs and interviews of organizations that conduct large-scale screening. No estimates of indirect costs were made.

Results
The direct medical expenditures for TB in 1991 were estimated at $703.1 million. This cost includes $423.8 million for inpatient care, $182.3 million for outpatient care, $72.1 million for screening, $3.4 million for contact investigations, $17.9 for preventive therapy, and $3.6 million for surveillance and outbreak investigations. Sensitivity analyses yielded a range of expenditures between $515.7 million and $934.5 million.

Conclusions
Treatment accounted for more than 86% of all TB-related expenditures; inpatient treatment accounted for 60% of the total. Prevention activities made up only 14% of all costs. Direct medical expenditures may be underestimated because of limitations in the database on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening activities. Greater emphasis should be placed on outpatient treatment and prevention in high-risk populations, and improved cost-accounting systems should be developed in state and local health department TB control programs to facilitate economic evaluation and improve the allocation of health dollars.

(Arch Intern Med. 1995;155:1595-1600)

Author Affiliations
From the Battelle Centers for Public Health Research and Evaluation, Arlington, Va (Mss Brown and Palmer and Dr Simpson); Centers for Disease Control and Prevention, Atlanta, Ga (Drs Miller, Taylor, and Nicola); Agency for Health Care Policy and Research, Center for Medical Effective Research (Dr Bosco); and Health Care Financing Administration, Medicaid Bureau (Dr Zelinger), Baltimore, Md.

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