Latent Tuberculosis Infection Testing and Treatment in the Private Sector: Evidence from Commercial Health Insurance Claims

Targeted identification and treatment of people with latent tuberculosis infection (LTBI) are key components of the US tuberculosis (TB) elimination strategy. Little research on LTBI testing and treatment has been conducted outside of public healthcare settings, so there is a dearth of information about the provision of LTBI-related services in the private sector environment. This gap was highlighted by recent health insurance-related regulatory changes that are expected to increase LTBI testing and treatment by private providers. Our research aimed to provide insight on the LTBI-related services provided to commercially insured individuals in the private sector setting. We analyzed a national sample of commercial insurance medical and pharmacy claims data from the Optum National Research Database for 4 million people ages 0 to 64; these data represented insurance-paid healthcare services received between January 2011 and December 2013 at minimum. We estimated private sector LTBI testing rates and examined patient characteristics associated with private sector LTBI testing. We also developed a claims-based method to identify LTBI treatment in the private sector and subsequently used this method to estimate treatment completion rates and identify clinical and system factors associated with treatment completion. We found that LTBI testing was not uncommon in the private sector and it is generally targeted to patients at the highest risk of TB/LTBI. Further, our claims-based method to identify and evaluate LTBI treatment successfully identified such treatment occurring in the private sector. Private sector LTBI treatment completion rates were in the range of those found in public health settings. Additionally, we identified factors unique to the private healthcare system that are associated with LTBI treatment completion. Our results suggest that the commercial sector may be a valuable adjunct to more traditional venues for TB prevention. Moreover, medical and pharmacy claims data and the claims-based methods we developed offer a means to gain important insights and open new avenues to monitor, evaluate, and coordinate TB prevention.