Open AccessImpact of Effective Global Tuberculosis Control on Health and Economic Outcomes in the United States
Author(s) -
Nicolas A Menzies,
Meghan Bellerose,
Christian Testa,
Nicole A. Swartwood,
Yelena Malyuta,
Ted Cohen,
Suzanne Marks,
Andrew Hill,
Anand Date,
Susan A. Maloney,
Sarah E. Bowden,
Ardath Grills,
Joshua A. Salomon
Publication year - 2020
Publication title -
american journal of respiratory and critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.272
H-Index - 374
eISSN - 1535-4970
pISSN - 1073-449X
DOI - 10.1164/rccm.202003-0526oc
Subject(s) - medicine , incidence (geometry) , tuberculosis , global health , productivity , environmental health , health care , demography , economic impact analysis , credible interval , public health , confidence interval , economic growth , economics , nursing , pathology , physics , sociology , optics , microeconomics
Rationale: Most U.S. residents who develop tuberculosis (TB) were born abroad, and U.S. TB incidence is increasingly driven by infection risks in other countries. Objectives: To estimate the potential impact of effective global TB control on health and economic outcomes in the United States. Methods: We estimated outcomes using linked mathematical models of TB epidemiology in the United States and migrants' birth countries. A base-case scenario extrapolated country-specific TB incidence trends. We compared this with scenarios in which countries achieve 90% TB incidence reductions between 2015 and 2035, as targeted by the World Health Organization's End TB Strategy ("effective global TB control"). We also considered pessimistic scenarios of flat TB incidence trends in individual countries. Measurements and Main Results: We estimated TB cases, deaths, and costs and the total economic burden of TB in the United States. Compared with the base-case scenario, effective global TB control would avert 40,000 (95% uncertainty interval, 29,000-55,000) TB cases in the United States in 2020-2035. TB incidence rates in 2035 would be 43% (95% uncertainty interval, 34-54%) lower than in the base-case scenario, and 49% (95% uncertainty interval, 44-55%) lower than in 2020. Summed over 2020-2035, this represents 0.8 billion dollars (95% uncertainty interval, 0.6-1.0 billion dollars) in averted healthcare costs and $2.5 billion dollars (95% uncertainty interval, 1.7-3.6 billion dollars) in productivity gains. The total U.S. economic burden of TB (including the value of averted TB deaths) would be 21% (95% uncertainty interval, 16-28%) lower (18 billion dollars [95% uncertainty level, 8-32 billion dollars]). Conclusions: In addition to producing major health benefits for high-burden countries, strengthened efforts to achieve effective global TB control could produce substantial health and economic benefits for the United States.