Predictors of Healthcare Costs among Commercially-Insured Persons with Tuberculosis in the United States, 2013 to 2018
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Context
Most individuals in the United States have commercial health insurance, yet costs for tuberculosis (TB) care have focused on the public sector.
Objective
To quantify 12-month all-cause healthcare costs and identify predictors of expenditure among commercially insured persons with TB disease in the United States.
Design/Setting
Retrospective cohort study using Merative™ MarketScan® Commercial Claims Database (2013–2018).
Participants
Adults ≥18 years old with TB disease
Main Outcome Measure
Total 12-month all-cause healthcare costs (outpatient, inpatient, pharmacy) were calculated from the date of diagnosis. Adjusted cost ratios (aCR) were estimated using a Gamma generalized linear model.
Results
We included 303 individuals diagnosed with TB disease, median age 46 years, 158 (52%) male, 16 (5%) with HIV, 12 (4%) with hepatitis B (HBV), and 13 (4%) with a drug use disorder. Mean total 12-month costs were $32,404 (median $8,075; SD $78,829). Median 12-month costs were substantially higher among persons with any comorbidity (HIV, HBV, hepatitis C (HCV), alcohol use disorder, drug use disorder, or Charlson score >0) compared to those without ($11,930 [IQR $4,194–$36,073] vs $3,385 [IQR $1,506–$8,609]; p<0.001). HIV coinfection and drug use disorder were the strongest independent predictors. HIV coinfection was associated with 4.7-fold higher costs (aCR 4.70, p<.001), driven predominantly by pharmacy expenditure (aCR 16.4). Drug use disorder was associated with 3.2-fold higher costs (aCR 2.62, p=.03). Comorbidity burden was a continuous independent predictor (aCR 1.36 per Charlson point, p<.001).
Conclusions
Healthcare costs are high among persons with TB who have commercial insurance, and are further increased with comorbidities including HIV coinfection and drug use disorder. Improved screening, care coordination and management of TB and high-risk comorbidities could yield significant cost savings.
