A cost-benefit analysis of a proposed overseas refugee latent tuberculosis infection screening and treatment program

Table 3 Types of Cost Incurred with Two Programs for Identifying and Treating LTBI in 100,000 U.S.-Bound Refugees^a

	LTBI Prevalence
	High (55 %)^b		Moderate (35 %)^b		Low (20 %)^b
	No overseas screening^c	Overseas screening^d	No overseas screening^c	Overseas screening^d	No overseas screening^c	Overseas screening^d
Type of cost
Overseas LTBI
TST	NA	$450,000	NA	$450,000	NA	$450,000
DOT Labor	NA	$669,000	NA	$426,000	NA	$246,000
Medications	NA	$3,629,000	NA	$2,312,000	NA	$1,336,000
U.S. LTBI
TST	$941,000	$415,000	$938,000	$605,000	$937,000	$746,000
DOT Labor	$555,000	$110,000	$351,000	$118,000	$201,000	$124,000
Medications	$1,043,000	$207,000	$660,000	$222,000	$377,000	$233,000
Active TB treatment	$12,851,000	$4,887,000	$6,426,000	$2,445,000	$1,666,000	$634,000
Difference in active TB treatment^e	$7,964,000		$3,981,000		$1,032,000
Total program	$15,389,000	$10,368,000	$8,376,000	$6,577,000	$3,181,000	$3,769,000
Net benefit or (cost)^f	$5,021,000		$1,799,000		($588,000)

DOT directly observed therapy, LTBI latent tuberculosis infection, TB tuberculosis, TST tuberculin skin test, U.S. United States
^aAll costs in 2012 U.S. dollars; ^bProportion TST positive; ^cAll LTBI screening and treatment takes place in U.S.; ^dRefugees screened with TST overseas, and TST positive refugees are offered treatment with 12 doses of once weekly rifapentine and isoniazid; ^eRepresents the reduction in U.S. incurred active TB costs with overseas screening and treatment programs; ^fA net benefit indicates that implementing overseas screening and treatment results in cost-savings while figures enclosed in parentheses indicate that there is an additional cost associated with overseas screening and treatment

ISSN: 1471-2458