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

Outbreak investigation is an essential component of tuberculosis (TB) control in the United States, but its epidemiologic impact and cost-effectiveness have not been quantified. We modeled outbreak investigation activities in the United States during 2023-2032 and estimated corresponding epidemiologic impact, economic costs (in 2022 US$), and incremental cost-effectiveness ratios from the healthcare system perspective (cost per additional quality-adjusted life-year gained). We projected that outbreak investigations would result in 1,030,000 (95% uncertainty interval [UI] 376,000- 1,740,000) contacts investigated, leading to 4,130 (95% UI 1,420-7,640) TB diagnoses and 104,000 (95% UI 37,600-181,000) latent TB infection diagnoses, at a total cost of US $219 million (95% UI $80-$387 million). We estimated that 5,560 (95% UI 1,720-11,400) TB cases would be averted through early detection and treatment, and the incremental cost-effectiveness of outbreak investigations, compared with no outbreak investigations, was $27,800 per quality-adjusted life-year gained (95% UI $4,580-$68,700).