HEALTH-CARE EXPENDITURES FOR TUBERCULOSIS IN THE UNITED-STATES

Background: The resurgence of tuberculosis (TB) and the increase in mu ltidrug-resistant TB prompted this study, which estimates direct expen ditures for TB treatment and public health activities in the United St ates. 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 Codma n Research Group, Lebanon, NH, were supplemented by surveys of state a nd local TB programs and interviews of organizations that conduct larg e-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 milli on for contact investigations, $17.9 for preventive therapy, and $3.6 million for surveillance and outbreak investigations. Sensitivity anal yses 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 to tal. Prevention activities made up only 14% of all costs. Direct medi cal expenditures may be underestimated because of limitations in the d atabase on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening a ctivities. Greater emphasis should be placed on outpatient treatment a nd prevention in high-risk populations, and improved cost-accounting s ystems should be developed in state and local health department TB con trol programs to facilitate economic evaluation and improve the alloca tion of health dollars.