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Return to Main Menu - TB Notes 1, 2008

Clinical and Health Systems Research Branch Update

A New Resource to Help Employers Prevent TB

In 2005, the National Business Group on Health began collaborating with CDC to produce A Purchasers Guide to Clinical Preventive Services: Moving Science into Coverage. The document, which became available in December 2006 both electronically and in hard copy, provides scientific evidence and clinical guidelines for effective ways to prevent illness and premature death from 46 conditions, including TB. The Guide is designed to help employers select and implement clinical preventive services.

The National Business Group on Health is a national non-profit association of 265 companies (many in the Fortune 500) interested in addressing its members’ provision-of-health-care issues. These businesses provide health care coverage, often through self-insurance mechanisms, for 50 million U.S. workers, retirees, and their families. Among the association’s members are Wal-mart, which is the nation’s largest employer (over 1 million low-income workers), and other employers in industries such as poultry processing, casinos/entertainment, communications / electronics / computer, hospitality, automobile manufacturing, oil and gas, fast food, and discount retail businesses. These employers often hire substantial numbers of persons who may be at high risk for TB, including many from countries of high TB prevalence.

Within the Purchasers’ Guide, for each condition there is a scientific evidence statement that includes information about the

  • Prevalence and/or incidence of the condition,
  • Risk factors associated with the condition,
  • Economic burden of the condition and the economic benefit of early identification/intervention,
  • Cost-benefit/cost-effectiveness of the recommended preventive intervention,
  • Cost of the recommended intervention,
  • Purpose of the recommended intervention, and
  • Benefits and risks of the recommended intervention.

Each condition’s clinical guidelines statement contains the covered screening procedures, periodicity for screening initiation and cessation, and Current Procedural Terminology (CPT) codes to facilitate the implementation and reimbursement of clinical preventive service benefits.

The TB clinical guidelines and evidence statements were derived from published CDC documents, such as the targeted testing, infection control, TB treatment, TB control, and contact investigation guidelines. In the document, CDC recommends targeted testing of persons at high risk for TB to identify and treat those found to have latent TB infection (LTBI) or TB. High-risk persons are defined as those who have had recent TB exposure, have a positive reaction to the tuberculin skin test (TST) or an interferon gamma release assay (IGRA) such as the QuantiFERON-TB Gold test), have had TB in the past, are immunosuppressed (including having HIV infection), are substance abusers, were born in a region of high TB-prevalence, are a low-income minority, reside in or are employed in a high-risk congregate setting, are health care workers who serve high-risk persons, or have a persistent cough for 2-3 weeks plus one additional TB symptom. Screening for TB is considered a covered benefit. For TB diagnosis, coverage may include use of chest radiographs, sputum induction, or mycobacterial smears and cultures. For LTBI, coverage may include use of the TST or an approved IGRA test.

The document also presents the scientific evidence for the value of preventing TB. Published articles summarize the burden of TB in the United States in terms of numbers of hospitalizations, inpatient days, and direct medical costs of TB care. Estimated costs of an LTBI screening and treatment effort are also provided.

Feedback since the document’s release suggests that it has been well received by the association’s members. It is hoped that the inclusion of tuberculosis in this guide will lead to improvements in screening, testing, and care for TB and LTBI among employees in the association’s industries.

The entire 494-page document is available for free .A Purchasers Guide to Clinical Preventive Services: Moving Science into Coverage. About halfway down the page is Condition Specific Information, which lists all 46 of the conditions in alphabetical order.

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