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. 2022 Sep;37(5):2697-2709.
doi: 10.1002/hpm.3496. Epub 2022 May 8.

A data driven policy to minimise the tuberculosis testing cost among healthcare workers

Vishnunarayan Girishan Prabhu  1 , Kevin M Taaffe  1 , Ronald G Pirrallo  2 , Dotan Shvorin  1
Affiliations

A data driven policy to minimise the tuberculosis testing cost among healthcare workers

Vishnunarayan Girishan Prabhu et al. Int J Health Plann Manage. 2022 Sep.

Abstract

Introduction: The Centres for Disease Control and Prevention (CDC) mandates that healthcare employees at high-risk exposure to Tuberculosis (TB) undergo annual testing. Currently, two methods of TB testing are used: a two-step skin test (TST) or a whole-blood test (IGRA). Healthcare leadership's test selection must account for not only direct costs such as procedure and resources but also indirect costs, including employee workplace absence.

Methods: A mathematical model based on Upstate South Carolina's largest health system affecting over 18,000 employees on six campuses was developed to investigate the value loss perspective of these testing methods and assist in decision-making. A process flow map identified the varied direct and indirect costs for each test for four employee types, and 6 travel-to-testing-site times were calculated.

Results: The switching point between testing procedures that minimised total system costs was most influenced by employee salary compared to travel distance. Switching from the current hospital policy to an integrated TST/IGRA testing could reduce TB compliance costs by 28%.

Conclusions: This study recommends an integrated approach as cost-effective for large health systems with multiple campuses while considering the direct and indirect costs. When accounting for 'inconvenience costs' (stress, etc.) associated with visits, IGRAs are recommended irrespective of employee salary.

Keywords: cost analysis; decision-making; healthcare policy; mathematical modelling; tuberculosis testing.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Skin Test (TST) process flow
FIGURE 2
FIGURE 2
Blood Test (IGRA QFT‐GIT) process flow
FIGURE 3
FIGURE 3
Assignment based on salary and travel time
FIGURE 4
FIGURE 4
Individual test cost for each combination of salary and travel time
See this image and copyright information in PMC

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