CDC Estimates for Latent TB Infection (LTBI) Treatment Costs (in 2020 U.S. dollars)

Table 1. Estimated 2020 LTBI Treatment Costs in the United States
LTBI Treatment Regimens Total Doses Total Medication Cost Cost/Dose Clinic Visits (n) DOT/Clinic Visits Supplies Cost AE Health System Cost Estimated Total Direct Cost Patient Time Cost due to DOT Patient Time Cost due to Clinic Visits Total Time Cost AE Societal Cost Estimated Total Societal Cost
6H (300) SAT 130 $25 $0.19 6 $257 $80 $11 $374 $189 $189 $12 $563
9H (300) SAT 720 $52 $0.19 9 $338 $92 $17 $499 $273 $273 $18 $773
4R (600) SAT 120 $78 $0.65 4 $203 $72 $11 $365 $132 $132 $12 $498
3HR (300,600) SAT 90 $76 $0.85 3 $176 $68 $34 $355 $104 $104 $37 $463
3HP1 (900,900) 100% SAT 12 $133 $11.12 3 $175 $68 $34 $412 $104 $104 $37 $520
3HP1 (900,900) 100% DOT 12 $133 $11.12 3 $412 $68 $34 $648 $27.99 $104 $132 $37 $783
LTBI = latent tuberculosis infection
6H = 6 months of daily doses of 300 milligrams (mg) of isoniazid
9H = 9 months of daily doses of 300 mg of isoniazid
4R = 4 months of daily doses of 600 mg of rifampin
3HR=3 months of daily doses of 300 mg of isoniazid and 600 mg. of rifampin
3HP = 3 months of weekly doses of 900 mg of isoniazid and 900 mg. of rifapentine
DOT = directly observed treatment
SAT = self-administered treatment
AE = adverse events

 

Excluding medication costs, which have been updated using U.S. Department of Veterans Affairs costs as listed below,1 CDC used values reported in a study from Shepardson et al.,2 which compared 9 months of daily doses of 300 milligrams (mg) of isoniazid using self-administered treatment (9H/SAT) to 3 months of once weekly doses of 900 mg of isoniazid and 900 mg of rifapentine using directly observed treatment (3HP/DOT), to estimate outpatient costs and non-mortality productivity losses in 2020 dollars for patients treated for latent TB infection (LTBI). The methods for updating costs from 2010 to 2020 dollars are described in the following paragraph. Cost estimates exclude those for LTBI testing but include TB disease screening costs.

Table 2 lists costs in 2010 dollars from Shepardson et al.2 that were used, next to their corresponding 2020 cost estimates. Updates to 2020 values for outpatient health services applied the Bureau of Economic Analysis Personal Consumption Expenditures (PCE) index for outpatient health services.3 Productivity losses in the societal perspective were updated using the Bureau of Labor Statistics change in the Average Hourly Earnings of Production and Nonsupervisory Employees index.4

Table 2. Estimated Cost per Patient in 2010 Compared to 2020

Cost per Patient† 2010 Dollars 2020 Dollars
Initial clinic visit $110.94 $122.48
Follow-up clinic visit $24.37 $26.91
Supplies for initial clinic visit $54.90 $60.61
Supplies for follow-up clinic visit $3.56 $3.93
Direct medical costs of 3HP adverse events $30.89 $34.10
Direct medical costs of 9H adverse events $14.98 $16.54
Societal costs of 3HP adverse events $33.81 $37.33
Societal costs of 9H adverse events $15.95 $17.61
Patient productivity losses
Initial clinic visit $37.05 $48.01
Follow-up clinic visit $21.73 $28.16
For DOT $1.80 $2.33

9H = 9 months of daily doses of 300 mg of isoniazid
4R = 4 months of daily doses of 600 mg of rifampin
3HP = 3 months of weekly doses of 900 mg of isoniazid and 900 mg of rifapentine
DOT = directly observed treatment
†Shepardson et. al.

To calculate the outpatient and productivity cost estimates for 6 months of daily doses of 300 mg of isoniazid monotherapy (6H), 4 months of daily doses of 600 mg of rifampin (4R), 3 months of daily doses of 300 mg of isoniazid and 600 mg of rifampin (3HR), and 3 months of weekly doses of 900 mg of isoniazid and 900 mg of rifapentine using self-administered treatment (3HP/SAT), we extrapolated outpatient and productivity cost estimates for 3HP and 9H from Shepardson et al. by changing the number of clinic visits to match treatment length and by removing directly observed treatment (DOT) costs. We assumed that adverse events for 3HR and 3HP/SAT would be similar to those for 3HP/DOT. Since rifampin alone (4R) typically results in fewer adverse events than for isoniazid containing regimens, we assumed $10 in 2010 dollars or $11 in 2020 dollars in direct medical adverse event costs and $11 in 2010 dollars or $12 in 2020 dollars in societal adverse event costs.

CDC obtained medication costs for treating LTBI from the U.S. Department of Veterans Affairs (VA)1 by National Drug Code (NDC) product identifier. While TB programs obtain their TB medications through the Health Resources and Services Administration (HRSA) 340B program of prices negotiated directly with pharmaceutical companies, neither HRSA nor TB programs are permitted to share their price data with CDC. So, CDC estimated TB medication costs from those obtained from the VA system, which similarly negotiates with pharmaceutical companies for prices much lower than advertised retail and wholesale prices. Costs were calculated for typical doses in milligrams (mg) for isoniazid (INH) plus $.02/dose for vitamin B6, rifampin (RIF), and rifapentine (RPT).

Table 3. Medication Cost Estimates*

Quantity Dose/Day Dose/Day VA VA
Medication NDC Mg Tablets per bottle # Tablets Dose in mg $/Bottle $/Dose
INH(300)+B6 00555-007 300 100 1 300 $17.42 $0.19
RIF (600) 00904-528 300 200 2 600 $65.13 $0.65
RPT (900) 00088-210 150 24 6 900 $42.16 $10.54
INH = isoniazid
RIF = rifampin
RPT = rifapentine
*U.S. Department of Veterans Affairs. National Acquisition Center. https://www.vendorportal.ecms.va.gov/nac/Pharma/Listexternal icon Accessed February 2019.

 

Inflation Adjustment Indices

2010 to 2020$ Outpatient Personal Consumption Expenditures 1.10406
2010 to 2020$ Average Hourly Earnings 1.29569
References

1 US Department of Veterans Affairs. National Acquisition Center. https://www.vendorportal.ecms.va.gov/nac/Pharma/Listexternal icon Accessed February 2020.

2 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. doi: 10.5588/ijtld.13.0423. PubMed PMID: 24200264; PubMed Central PMCID: PMC5451112.

3 Bureau of Economic Analysis Personal Consumption Expenditures (PCE) indices for hospital and outpatient healthcare services. Table 2.4.4 https://apps.bea.gov/iTable/iTable.cfm?reqid=19&step=2#reqid=19&step=2&isuri=1&1921=surveyexternal icon

4 Average hourly earnings of production and nonsupervisory employees, total private, not seasonally adjusted. https://data.bls.gov/cgi-bin/srgateexternal icon series CEU0500000008.