Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #99677

Diana P. Forno-Batres, BS, MD, MPH¹, H. Paul Brumund, BS², Maria Frontini, DVM, MPH, MS, PhD³, and Nancy Welch, MD MHA MBA². (1) Graduate Program in Public Health, Eastern Virginia Medical School, 729 Willow Brook Rd., Chesapeake, VA 23320, (757) 382-9101, fornodp@aol.com, (2) Epidemiologist, Chesapeake Health Department, 748 Battlefield Blvd., North, Chesapeake, VA 23320, (3) Epidemiology-Biostatistics Core, Eastern Virginia Medical School, 700 Olney Road, Lewis Hall, Suite 1100, Norfolk, VA 23507

Background: Tuberculosis (TB) reemerged within the United States' health care settings in the early 1990's, increasing the costs related to its treatment, control and prevention. A retrospective study showed that the national medical expenditures for TB were an estimated $703.1 million, including a total of $3.4 million for contact investigations. On June 12, 2004, a nurse who worked at a community hospital in Virginia died of TB. A contact investigation was initiated immediately by the local and state health departments as well as the community hospital were the nurse worked.

Objectives: To assess the total financial costs of the 2004 TB exposure investigation incurred by the local and state departments as well as the community hospital.

Methods: The information from the TB screening database was reviewed. To calculate salaries, a composite rate was estimated according to salary rate and hours worked during the investigation. The total costs associated with the TB exposure investigation were estimated according to traceability in two main categories; direct and indirect costs. Within the category of direct costs, the costs were divided in four subcategories; salaries, medical supplies, office supplies and other. The indirect category included the administrative overhead costs. Results: From 2556 individuals who responded to the massive campaign for TB screening, 2300 met the criteria as being at risk for TB and were given a tuberculin skin test (TST). There was a positive rate of 6%. Total costs of the TB contact investigation were an estimated $488,284.63. Total direct costs of the investigation were an estimated $453,809.98 and total indirect costs were an estimated $34,474.65. The cost of medication, chest X-rays and case management was covered by the community hospital.

Conclusions: The total costs incurred by the community hospital during this contact investigation ($325,000) were higher than the annual cost of implementing and maintaining a TB screening program among healthcare workers (HCW) in hospitals. ($66,564 to $278,731) The total costs incurred by the local Health Department were also higher ($110,869.11) than the annual cost of a TST program for HCW in health departments, which can range between $92,886 and $103,138. TB prevention in HCW should be highly emphasized by hospitals as well as local and state departments. It is more cost-effective to implement active surveillance of TB among high risk populations, rather than to use financial resources for costly contact investigations, diagnostic procedures and medications.

Learning Objectives: Participants will be able to

• Describe the direct and indirect costs incurred by the community hospital during the 2004 tuberculosis exposure investigation.
• Describe the direct and indirect costs incurred by the local and state health departments, during the 2004 tuberculosis exposure investigation.
• Assess the cost per patient during the 2004 tuberculosis exposure investigation.
• Recognize the cost effectiveness of tuberculosis surveillance compared to exposure investigations.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation