CDC Estimates for Latent TB Infection (LTBI) Treatment Costs (in 2020 U.S. dollars)

Excluding medication costs, which have been updated using U.S. Department of Veterans Affairs costs as listed below,¹ CDC used values reported in a study from Shepardson et al.,² which compared 9 months of daily doses of 300 milligrams (mg) of isoniazid using self-administered treatment (9H/SAT) to 3 months of once weekly doses of 900 mg of isoniazid and 900 mg of rifapentine using directly observed treatment (3HP/DOT), to estimate outpatient costs and non-mortality productivity losses in 2020 dollars for patients treated for latent TB infection (LTBI). The methods for updating costs from 2010 to 2020 dollars are described in the following paragraph. Cost estimates exclude those for LTBI testing but include TB disease screening costs.

Table 2 lists costs in 2010 dollars from Shepardson et al.² that were used, next to their corresponding 2020 cost estimates. Updates to 2020 values for outpatient health services applied the Bureau of Economic Analysis Personal Consumption Expenditures (PCE) index for outpatient health services.³ Productivity losses in the societal perspective were updated using the Bureau of Labor Statistics change in the Average Hourly Earnings of Production and Nonsupervisory Employees index.⁴

Table 2. Estimated Cost per Patient in 2010 Compared to 2020

9H = 9 months of daily doses of 300 mg of isoniazid
4R = 4 months of daily doses of 600 mg of rifampin
3HP = 3 months of weekly doses of 900 mg of isoniazid and 900 mg of rifapentine
DOT = directly observed treatment
†Shepardson et. al.

To calculate the outpatient and productivity cost estimates for 6 months of daily doses of 300 mg of isoniazid monotherapy (6H), 4 months of daily doses of 600 mg of rifampin (4R), 3 months of daily doses of 300 mg of isoniazid and 600 mg of rifampin (3HR), and 3 months of weekly doses of 900 mg of isoniazid and 900 mg of rifapentine using self-administered treatment (3HP/SAT), we extrapolated outpatient and productivity cost estimates for 3HP and 9H from Shepardson et al. by changing the number of clinic visits to match treatment length and by removing directly observed treatment (DOT) costs. We assumed that adverse events for 3HR and 3HP/SAT would be similar to those for 3HP/DOT. Since rifampin alone (4R) typically results in fewer adverse events than for isoniazid containing regimens, we assumed $10 in 2010 dollars or $11 in 2020 dollars in direct medical adverse event costs and $11 in 2010 dollars or $12 in 2020 dollars in societal adverse event costs.

CDC obtained medication costs for treating LTBI from the U.S. Department of Veterans Affairs (VA)¹ by National Drug Code (NDC) product identifier. While TB programs obtain their TB medications through the Health Resources and Services Administration (HRSA) 340B program of prices negotiated directly with pharmaceutical companies, neither HRSA nor TB programs are permitted to share their price data with CDC. So, CDC estimated TB medication costs from those obtained from the VA system, which similarly negotiates with pharmaceutical companies for prices much lower than advertised retail and wholesale prices. Costs were calculated for typical doses in milligrams (mg) for isoniazid (INH) plus $.02/dose for vitamin B6, rifampin (RIF), and rifapentine (RPT).

Table 3. Medication Cost Estimates*

Inflation Adjustment Indices