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Volume 31, Number 3—March 2025
Research

Model-Based Analysis of Impact, Costs, and Cost-Effectiveness of Tuberculosis Outbreak Investigations, United States

Sourya ShresthaComments to Author , Lucia Cilloni, Garrett R. Beeler Asay, J. Steve Kammerer, Kala Raz, Tambi Shaw, Martin Cilnis, Jonathan Wortham, Suzanne M. Marks, and David Dowdy
Author affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (S. Shrestha, L. Cilloni, D. Dowdy); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (G.R.B. Asay, J.S. Kammerer, K. Raz, J. Wortham, S.M. Marks); California Department of Public Health, Richmond, California, USA (T. Shaw, M. Cilnis)

Main Article

Table 1

Descriptions, estimates and uncertainty ranges for parameters describing TB outbreaks and outbreak investigations in study of impact, costs, and cost-effectiveness of TB outbreak investigations, United States*

Model parameters Point estimate Lower value Upper value Sources and additional notes
Projection of TB cases and outbreaks
Projected decline in TB cases, year-on-year % decline 1.06% 0% 2% Based on year-on-year % decline in TB cases in the United States, 2014–2019 (1).
Change in TB incidence from the projected baseline because of other factors (e.g., COVID pandemic) No change 10% decrease 5% increase Assumption. If is the annual rate of decline in TB cases before the pandemic, and is the impact of the pandemic, then the number of TB cases projected in the year is given by:
.
R0 0.29 0.19 0.38 Shrestha et al. (12)†
Individual level heterogeneity, SD of the Poisson lognormal model
 1.9
 1.8
 2
 Shrestha et al. (12)†
Characterization of outbreak investigation
Outbreak investigation threshold >3 cases Assumption, as in Mindra et al. (2).
No. contacts investigated per case during outbreak investigation 55 10 78 Mitruka et al. (3) reported 42 total contacts investigated per case among 27 outbreaks during 2002–2008; Mindra et al. (2) reported 88 contacts per case among 21 outbreaks during 2009–2015. We assumed that on average 10 contacts would be evaluated per case outside of outbreak investigation, on the basis of ARPE report (13), and that 5% of the case investigations occur as a part of outbreak investigation (Appendix).
% Contacts evaluated 79% 75% 85% ARPE report (13)
% LTBI diagnoses in evaluated contacts 13% 10% 15% Mitruka et al. (3), ARPE report (13)
% Contacts with LTBI initiating LTBI treatment 73% 70% 75% ARPE report (13)
% Contacts with LTBI completing LTBI treatment 57% 55% 65% ARPE report (13); this is a product of the percentage of contacts with LTBI initiating treatment, and percentage of those initiating that complete treatment.
% Evaluated contacts with TB disease 0.5% 0.29% 0.72% Mitruka et al. (3) reports 0.62%; 0.72% by ARPE report (13); Mindra et al. (2) reports 0.29%.

*3HP, 3 months of isoniazid and rifapentine; 9H, 9 months of isoniazid; ARPE, Aggregate Reports for Program Evaluation; CDC, Centers for Disease Control and Prevention; IGRA, interferon-γ release assay; LTBI, latent TB infection; QALY, quality-adjusted life-years; R0, basic reproduction number; TB, tuberculosis. †Based on Poisson lognormal distributions fitted to cluster-size distribution of genotype linked cases in the United States during 2012–2016.

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