CDC Estimates for TB Treatment Costs (in 2020 U.S. Dollars)
For 2020, CDC updated costs using the Bureau of Economic Analysis Personal Consumption Expenditures (PCE) separate indices for hospital and outpatient healthcare services,1 rather than the Consumer Price index for Medical Care (CPI/MC)2 as was done for cost estimates in years before 2018. CDC updated productivity losses using the Bureau of Labor Statistics Private Sector Average Hourly Earnings of Production and Nonsupervisory Employees.3
In 2020, CDC used average hospitalization cost estimates for a TB hospitalization episode, adjusted for patient and hospitalization characteristics (Aslam et al.)4 of $16,695 per episode (in 2014 dollars) plus 20% for physician fees or $3,339 (estimated by Aslam in 2014 dollars), divided by an average 15.6 days per episode, multiplied by an estimated 24 days per patient with TB disease hospitalized over multiple episodes (Shepardson et al.)6 , and updated to 2020 dollars using the inpatient PCE ($34,520 per patient in 2020 dollars). The estimate of percentage of patients without multidrug-resistant (MDR) TB disease who are hospitalized was 49% (Taylor et al.).7 Outpatient TB disease costs (Shepardson et al.)6 were added to drug-susceptible inpatient cost estimates. The value of remaining lifetime lost productivity (including household productivity and assuming 0.5% annual productivity growth) from premature mortality due to TB disease was estimated at $574,751 in 2016 dollars at age 65 (Grosse et al.),8 updated to 2020 dollars as stated above. Nine percent of patients with TB disease were estimated to have been diagnosed with TB disease at death or to have died during treatment for TB disease;9 72% of deaths were estimated to have been probably caused by TB disease (Beavers et al.).10
MDR TB and extensively drug-resistant (XDR) TB morbidity cost estimates derived from Marks et al.11 were updated to 2020 dollars using the PCE. Estimated non-mortality productivity losses for MDR or XDR TB (Marks et al.)11 were updated to 2020 dollars using its methods (i.e., the change in hourly earnings). Also, from that study, 7% of the study sample died from TB disease, for whom the average age at death was 55, and each death was valued at $1,031,513 in 2020 dollars, as described above. Since no mortality was found among the small number of patients with XDR TB disease (Marks et al.)11, and since deaths due to XDR TB disease were considered to be a likely occurrence in the future, the same percentage of patients with XDR TB disease were estimated to die as of patients with MDR TB disease and costs estimated similarly.
|2020 U.S. Dollars||Average||Average|
|Cost/Case||Non-MDR TB*||MDR TB**||XDR TB**|
|Direct Treatment Costs||$ 20,211||$ 182,186||$ 567,708|
|Societal w/o deaths||$ 24,661||$ 347,324||$ 729,039|
|Societal w/ deaths||$ 67,337||$ 419,530||$ 801,245|
|Inflation Adjustment Indices|
|2010 to 2020 dollars||PCE Outpatient||1.104061|
|2010 to 2020 dollars||PCE Inpatient||1.21330|
|2010 to 2020 dollars||Avg Hourly Earnings||1.295693|
|2016 to 2020 dollars||Avg Hourly Earnings||1.14584|
Note: The $503M total cost estimate is the sum of societal cost estimates for drug susceptible, MDR, and XDR TB disease for 2020, by applying societal cost/case estimates to the final TB case counts. The total cost estimate is lower compared with previous years because of an approximate 20% decline in TB cases reported in 2020 in the United States.
* Drug-susceptible TB inpatient costs, updated to 2020 dollars (Aslam et al.), of $1,438/day, multiplied by 24 days per patient over all episodes, multiplied by 49% of patients with TB disease hospitalized (Taylor et al.), plus an estimated $3,296 in outpatient costs (Shepardson et al.). Productivity losses, updated to 2020 dollars, during hospitalization ($4,048) and during outpatient care ($403) were estimated (Shepardson et al.). Societal premature deaths were valued using the adjusted human capital method (Grosse et al.) at $574,751 at median age at death of 65 in 2016 dollars ($658,574 in 2020 dollars) with 9% of TB disease-associated deaths (7% died during treatment and 2% diagnosed after death), and 72% of deaths likely due to TB disease (Beavers et al.).
** MDR and XDR TB outpatient ($76,000; $201,000 in 2010 dollars respectively, or $83,909; $221,916 in 2020 dollars) and inpatient costs ($81,000; $285,000 in 2010 dollars respectively, or $98,278; $345,792 in 2020 dollars) (Marks et al.). Productivity losses for patients with MDR TB disease without mortality were estimated at $127,451; or $165,137 in 2020 dollars. For patients with XDR TB disease without mortality, productivity loss estimates were $124,513; or $161,331 in 2020 dollars. Average age at death for patients with MDR or XDR TB disease was 55 and 7% were estimated to have died from MDR or XDR TB disease. Deaths were valued at $1,031,513 each in 2020 dollars.
1 Bureau of Economic Analysis Personal Consumption Expenditures (PCE) indices for hospital and outpatient healthcare services. https://apps.bea.gov/iTable/iTable.cfm?reqid=19&step=2#reqid=19&step=2&isuri=1&1921=surveyexternal icon
2 Bureau of Labor Statistics. Consumer Price Index for Medical Care Services: https://data.bls.gov/cgi-bin/srgateexternal icon series CUUR0000SAM.
3 Average hourly earnings of production and nonsupervisory employees, total private, not seasonally adjusted. https://data.bls.gov/cgi-bin/srgateexternal icon series CEU0500000008.
4 Aslam MV, Owusu-Edusei K, Marks SM, Asay GRB, Miramontes R, Kolasa M, Winston CA, Dietz PM. Number and cost of hospitalizations with principal and secondary diagnoses of tuberculosis, United States. Int J Tuberc Lung Dis. 2018; 22(12):1495-1504.
5 Peterson C, Xu L, Florence C, et al. Professional fee ratios for US hospital discharge data. Med Care 2015; 53: 840–849.
6 Shepardson D, Marks SM, Chesson H, Kerrigan A, Holland DP, Scott N, Tian X, Borisov AS, Shang N, Heilig CM, Sterling TR, Villarino ME, Mac Kenzie WR. Cost-effectiveness of a 12-dose regimen for treating latent tuberculous infection in the United States. Int J Tuberc Lung Dis. 2013;17(12):1531-7.
7 Taylor Z, Marks SM, Ríos Burrows NM, Weis SE, Stricof RL, Miller B. Causes and costs of hospitalization of tuberculosis patients in the United States. Int J Tuberc Lung Dis. 2000 Oct;4(10):931-9.
8 Grosse SD, Krueger KV, Pike J. Estimated annual and lifetime labor productivity in the United States, 2016: implications for economic evaluations. J Med Econ. 2019; 22(6):501-508. doi: 10.1080/13696998.2018.1542520
9 Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 2017. Atlanta, GA: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination; 2018.
10 Beavers SF, Pascopella L, Davidow AL, Mangan JM, Hirsch-Moverman YR, Golub JE, Blumberg HM, Webb RM, Royce RA, Buskin SE, Leonard MK, Weinfurter PC, Belknap RW, Hughes SE, Warkentin JV, Welbel SF, Miller TL, Kundipati SR, Lauzardo M, Barry PM, Katz DJ, Garrett DO, Graviss EA, Flood JM; Tuberculosis Epidemiologic Studies
Consortium. Tuberculosis Mortality in the United States: Epidemiology and Prevention Opportunities. Ann Am Thorac Soc. 2018 Feb 28. doi: 10.1513/AnnalsATS.201705-405OC.
11 Marks SM, Flood J, Seaworth B, Hirsch-Moverman Y, Armstrong L, Mase S, Salcedo K, Oh P, Graviss EA, Colson PW, Armitige L, Revuelta M, Sheeran K; TB Epidemiologic Studies Consortium. Treatment practices, outcomes, and costs of multidrug-resistant and extensively drug-resistant tuberculosis, United States, 2005-2007. Emerg Infect Dis. 2014;20(5):812-21.