TB prevention response in US averts up to 319,000 cases from 1995-2014
Prevention and control efforts in the United States appear to have averted as many as 318,948 tuberculosis deaths from 1995 to 2014 and could be responsible for an economic societal benefit ranging from $6.7 billion to $14.5 billion for the period, according to modeling analysis data.
“In the mid-1980s and early 1990s, the reversal of the longstanding downward trend in TB incidence was fueled by several converging factors: the onset of the HIV epidemic, increases in TB cases among foreign-born persons, outbreaks in congregate settings and delays in recognizing the appearance and transmission of deadly, drug-resistant TB strains,” Philip A. LoBue, MD, director of the division of TB elimination at the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, told Infectious Disease News.
“The urgency of the situation prompted the launch of national, multi-agency TB response, which proved to be highly effective. Findings from the analysis estimate as many as 300,000 TB cases were prevented, and billions of dollars in health care costs averted following the concerted public health response.”
LoBue and colleagues examined nationwide TB case data collected from the National Tuberculosis Surveillance System (NTSS) as well as incidence reported by state TB programs. To estimate the impact of TB prevention efforts during the past few decades, they used these data to identify the total and annual change in TB cases from 1992 to 2014, and compared those findings with the following hypothetical scenarios:
- static annual TB incidence rates among foreign-born and U.S.-born individuals (scenario 1);
- static annual TB incidence rates among foreign-born individuals, but a 5.1% annual decline among U.S.-born individuals (scenario 2); and
- annual TB incidence rates as determined by a model incorporating various HIV and TB indices (statistical model).
The researchers reported a total of 368,184 incident TB cases in the U.S. from 1992 to 2014, with the annual number of cases declined from 26,673 to 9,421 during this time period (average annual percentage change, 4.6%). When comparing these rates with those demonstrated in the three models, the estimated total number of TB cases averted from 1995-2014 ranged from 144,852 (scenario 2) to 318,948 (scenario 1). Cases averted in the statistical model were 157,497. Based on the average cost of treating each case of TB and multidrug-resistant TB, as well as the loss of productivity due to death, the researchers estimated the societal benefit of TB prevention to be $14.5 billion (scenario 1), $6.7 billion (scenario 2) and $7.3 billion (statistical model).
While these estimates suggest current prevention tactics have had a “tremendous public health and economic impact,” LoBue stressed the importance of more ambitious programs to fully eliminate TB in the U.S.
“We have made great strides toward TB elimination over the past 2 decades,” LoBue said. “However, it is clear that current efforts will not achieve elimination in the foreseeable future because of persistent spread of TB disease in certain groups and our inability to address the large pool of individuals with latent TB infection who are at risk for becoming ill. If we accept the status quo, not only will progress toward TB elimination continue to stall, but we become vulnerable to another resurgence.”
Castro KG, et al. Int J Tuberc Lung Dis. 2016;doi:10.5588/ijtld.15.1001
Source: Healio
