Date of Award
5-9-2014
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Public Management and Policy
First Advisor
Dr. John Thomas
Second Advisor
Dr. Victoria Phillips
Third Advisor
Dr. Gregory Lewis
Fourth Advisor
Dr. Karen Minyard
Fifth Advisor
Dr. Aaron Levine
Abstract
Preventative interventions often demand that resources be consumed in the present in exchange for future benefits. Cost-effectiveness analysis is a tool to understand these trade-offs, and inform decision-making under resource constraints. Targeted testing and treatment (TTT) for latent tuberculosis infection (LTBI) consists in identifying people at high risk for LTBI for preventive treatment to decrease the risk of active tuberculosis disease (ATBD). The state of Tennessee began conducting TTT statewide in 2001.
This study uses a decision tree to evaluate the cost and outcomes of TTT for LTBI in Tennessee, compared to passive ATBD case finding (PACF). Key probabilities were obtained from the Tennessee TTT program and the literature. Outcomes are measured in terms of Quality Adjusted Life Years (QALY). The cost-effectiveness threshold was $100,000/QALY saved. One-way sensitivity analyses around factors related to study design, the program’s environment, and program performance were conducted, as was probabilistic sensitivity analysis (PSA) which takes into account the uncertainty in multiple parameters simultaneously.
The base case, with a 25-year analytic horizon and 3% discount rate, shows that TTT prevents 47 ATBD cases, and saves 31 QALYs per 100,000 patients screened at a societal cost of $12,579 per QALY saved. Sensitivity analyses identified value thresholds that would trigger a change in preferred policy. PSA shows that the likelihood that TTT would be cost-effective is low.
Decision makers should carefully assess the characteristics of the local TB epidemic and expected program performance to determine whether TTT is preferable over PACF from a cost-effectiveness viewpoint.
DOI
https://doi.org/10.57709/5451503
Recommended Citation
Ferroussier-Davis, Odile, "Is Targeted Testing and Treatment for Latent Tuberculosis Infection Cost-effective? The Experience of Tennessee." Dissertation, Georgia State University, 2014.
doi: https://doi.org/10.57709/5451503