This tool is a web application that shows the projected epidemiological
impact, corresponding costs, and cost-effectiveness, of increased
targeted testing and treatment on tuberculosis incidence among different
high-risk populations in
four states: California, Florida, New York and Texas. Targeted testing
and treatment (TTT) is an important TB prevention and control strategy
that is used to identify, evaluate, and treat people who are at high
risk for latent TB infection (LTBI) or at high
risk for active TB disease once infected. Based on state-level TB
transmission models, members of the CAMP team at Johns Hopkins and CDC
estimated the impact of TTT (compared to the absence of any additional
intervention) as the percent reduction in the projected
baseline TB incidence, from 2016 through 2025, among five high-risk
groups (people who are non-US-born, diabetic, HIV-positive, homeless or
incarcerated) in the four most populous US states (California, Florida,
New York and Texas). Costs of TTT (from the
healthcare system perspective, in 2016 dollars) and incremental cost
effectiveness (cost per quality-adjusted life year [QALY] gained) are
evaluated over a 30 year horizon based on outputs from the
epidemiological model (i.e., numbers of people screened, diagnosed
and treated; number of TB cases averted) and combine these with
state-specific estimates of the direct medical cost of TB screening,
diagnosis, and treatment. Users can observe the impact of TTT among
individually, and compare these values to the total impact,
cost profile and cost effectiveness of TTT if implemented across all
five high-risk groups together in each state. While many state health
departments may be aware of which populations in their specific state
are at highest risk for TB disease, showing the
projected impact of TB interventions within these key populations
across all states provides a basis for measurable improvement.
Importantly, differences in TTT impact between states may mean that
different states have different needs and priorities regarding
the reduction of TB incidence by risk group. User-friendly online tools
can thus aid state and local jurisdictions in decision-making about
resource allocation in TB control and prioritization of TB elimination
activities, and are complementary to the state
TB epidemiology reports.
Use The Tool