TABLE 2.
NET BENEFITS TO U.S. TAXPAYERS OF ELIMINATING TUBERCULOSIS (TB) HOSPITALIZATIONS IN PERSONS AT HIGH RISK FOR TB HOSPITALIZATION
DAYS/PATIENT |
COST/PATIENT/DAY (1999
DOLLARS) |
TOTAL U.S. COST (1999
DOLLARS) |
||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
STUDY PATIENTS | U.S. PATIENTSa | FIRST QUARTILE | MEDIAN | AVERAGE | THIRD QUARTILE | FIRST QUARTILE | MEDIAN | AVERAGE | THIRD QUARTILE | FIRST QUARTILE | MEDIAN | AVERAGE | THIRD QUARTILE | |
Direct | ||||||||||||||
Hospital procedures/medications | 490 | 7,538 | 7 | 13 | 27 | 25 | 489 | 623 | 736 | 877 | 25,802,574 | 61,050,262 | 149,795,136 | 165,270,650 |
Physician | 490 | 7,538 | 7 | 13 | 27 | 25 | 21 | 21 | 21 | 21 | 1,108,086 | 2,057,874 | 4,274,046 | 3,957,450 |
Total direct costs | 510 | 644 | 757 | 898 | 26,910,660 | 63,108,136 | 154,069,182 | 169,228,100 | ||||||
Indirect | ||||||||||||||
Productivity losses | 490 | 7,538 | 7 | 13 | 27 | 25 | 93.11 | 93.11 | 93.11 | 93.11 | 4,913,042 | 9,124,221 | 18,950,306 | 17,546,580 |
Total indirect costs | 93 | 93 | 93 | 93 | 4,913,042 | 9,124,221 | 18,950,306 | 17,546,580 | ||||||
Total direct and indirect costs | 603 | 737 | 850 | 991 | 31,823,702 | 72,232,357 | 173,019,488 | 186,774,680 | ||||||
Costs of preventing TB hospitalizations | ||||||||||||||
Targeting testing and treatment for latent TB infectionb | 490 | 7,538 | 270 | 270 | 270 | 270 | 1 | 1 | 1 | 1 | 2,035,260 | 2,035,26 | 2,035,260 | 2,035,260 |
Housing/food/social worker for homelessc | 96 | 1,477 | 270 | 270 | 270 | 270 | 21 | 21 | 21 | 21 | 8,374,590 | 8,374,590 | 8,374,590 | 8,374,590 |
Directly observed treatment two times a week for nine monthsd | 490 | 7,538 | 72 | 72 | 72 | 72 | 42 | 42 | 42 | 42 | 22,794,912 | 22,794,912 | 22,794,912 | 22,794,912 |
Liver exams in HIV-positive patientse | 117 | 1,800 | 9 | 9 | 9 | 9 | 19 | 19 | 19 | 19 | 307,800 | 307,800 | 307,800 | 307,800 |
Anti-AIDS medicationsf | 117 | 1,800 | 270 | 270 | 270 | 270 | 41 | 41 | 41 | 41 | 19,926,000 | 19,926,000 | 19,926,000 | 19,926,000 |
Substance abuse treatmentg | 277 | 4,262 | 270 | 270 | 270 | 270 | 13 | 13 | 13 | 13 | 14,959,620 | 14,959,620 | 14,959,620 | 14,959,620 |
Total costs of prevention | 124 | 124 | 124 | 124 | 68,398,182 | 68,398,182 | 68,398,182 | 68,398,182 | ||||||
Net benefits to U.S. taxpayers | 479 | 613 | 726 | 867 | (36,574,480) | 3,834,175 | 104,621,306 | 118,376,498 |
Note: This table shows the costs of eliminating TB hospitalizations in high-risk persons (homeless, HIV-positive, non-Hispanic blacks, substance abusers, correctional facility residents, multidrug resistant TB patients, or long-term care residents paid for by the public sector or uninsured in public hospitals).
Since the study patients represented 6.5 percent of U.S. TB patients, U.S. patients = study patients divided by 6.5 percent.
Costs of TB testing (tuberculin skin test [TST], follow-up TST, chest radiograph, sputum exam) and treatment for latent TB infection (nine months of isoniazid or four months of rifampin).
Nine months of housing (fair market rent for two bedroom $415 adjusted to 80 percent for an efficiency), food (U.S. Stat Abstract Table 760 liberal plan adjusted upward by 20 percent for a single male), and one day of $35,000 annual salary social worker.
Cost of directly observed treatment.
Nine monthly liver enzyme exams.
Nine months of anti-AIDS medications at $15,000 per year, estimate.
Nine months of outpatient substance abuse treatment.