Determining the cost of tuberculosis case management in a low-incidence state

OBJECTIVE: To establish the average cost per patient of nurse case management for tuberculosis (TB) in Oregon State and so facilitate estimates of the overall cost of TB treatment. TB treatment is currently funded by a combination of local, state and federal public health dollars. DESIGN: A longitudinal survey was used to assess the amount of case management time patients required per week. Additional patient information was collected from public health records. Mixed effects modeling techniques were used to identify important factors associated with case management time and to make predictions. RESULTS: The following variables were significantly associated with case management time: non-adherence to treatment, the use of incentives, the phase of treatment and the presence of complicating factors, including human immunodeficiency virus infection, antibiotic resistance, homelessness and adverse reaction to drugs. The mean case management cost was $4831 per patient for a standard 28-week treatment course, and ranged from $3386 for a simple case to $7542 for a case with multiple complications. CONCLUSIONS: These estimates are substantially higher than the current state funding for case management. Using these data, health officials can make better informed budget decisions and provide more appropriate support for TB control.