Development of a Costing and Cost-Effectiveness Framework to Compare Tuberculosis Infection Tests in a High-Burden Setting

  • Investigator: Meredith Brooks
  • Funding Source: QIAGEN

We aim to develop a framework to estimate the practical costs incurred from, and programmatic impact related to, tuberculosis (TB) infection testing—tuberculin skin tests (TST) versus interferon gamma release assay (IGRA)—in a densely populated high-burden TB area. We will develop a seven-step framework that can be tailored to individual TB programs to inform decision-making around costing for comparing different TB infection diagnostics. We will present methodology to calculate (1) the prevalence of TB infection, (2) the rate of observed, true, and false positives and negatives for each test, (3) the cost of test administration, (4) the cost of false negatives, (5) the cost of treating all that test positive, (6) the per-test cost incurred due to treatment and misdiagnosis, and (7) the threshold at which laboratory infrastructure investments for IGRA become cost effective over TST. We will then applied this framework in a densely populated, peri-urban district in Lima, Peru with high rates of BCG vaccination.

Prevention Policy Modeling Lab

  • Investigator: C. Robert Horsburgh
  • Funding Source: Centers for Disease Control and Prevention

Important epidemiologic and policy changes that are reshaping national and local health landscapes necessitate a renewed focus on disease prevention and health promotion, and on strategic decision-making to prioritize programs for maximum impact and efficiency. The Prevention Policy Modeling Lab models the health impact, costs and cost-effectiveness of infectious disease treatment and prevention programs in the United States. We work closely with collaborators in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) at the Centers for Disease Control and Prevention to inform U.S. health policy and guide public health decision-making at national, state and local levels. The models we build incorporate evidence-based prevention strategies, emphasize cross-cutting initiatives and produce results that can be operationalized within healthcare and other sectors.

    The Economic Burden of Inaction Against Tuberculosis Disease

    • Investigator: Meredith Brooks
    • Funding Source: Dubai Harvard Foundation for Medical Research, Harvard Medical School Center for Global Health Delivery

    Implementing a comprehensive program in a high tuberculosis-burden setting can be difficult with predetermined, limited budgets designed around minimalist interventions over short timescales, which may lead to missing numerous patients. We aim to develop a framework to estimate the cost to society of a single missed tuberculosis patient. These costs include those for medications, lost productivity of those who are ill, burdens on the healthcare system, and costs of furthered transmission. We then apply this framework in the Indian context.