Impact of targeted testing and treatment of Mtb infection among Asian and Hispanic persons with diabetes in the United States: results from a dynamic transmission model
This project estimates the impact of a one time, universally offered targeted testing and treatment intervention (TTT) for latent tuberculosis (TB) infection among non-Hispanic Asian and Hispanic persons with Diabetes in the United States. The analysis has three key steps:
LTBI prevalence and LTBI/Diabetes co-prevalence is estimated using the 2011-2012 National Health and Nutrition Survey.
Diabetes prevalence is estimated using 2020-2022 National Health Interview Survey.
Population estimates are from 2022 ACS data.
LTBI
We adjust reported IGRA+ prevalence by test sensitivity and specificity to estimate true LTBI prevalence. This data is the most recent nationally representative LTBI data.
Diabetes
We aimed to identify diagnosed diabetes. Individuals were determined to have diabetes if they indicated they had been diagnosed with diabetes by a health professional, other than during pregnancy (for females).
We define each of the screened population by key characteristics:
- population size
- age distribution
- nativity distribution
- LTBI prevalence
- Risk of progressing from LTBI to TB disease
- All-cause mortality risk
These populations are passed into the model where we simulate the LTBI care cascade from the offer of LTBI testing to the effectiveness of treatment.
We output the impact on TB cases and deaths with TB.
Step 3: Use TB cost calculator (TubercuCost) to estimate the associated economic costs and cost effectiveness of the intervention
The estimated TB cases and deaths with TB from the transmission model serve as the inputs to this calculator.
We estimate the cost from three perspectives:
- TB health services perspective
- All health services perspective
- Societal perspective
All costs are reported in 2022 U.S. dollars and are discounted at 3% annually.