Public policy, private practice: Tuberculosis/latent tuberculosis infection (TB/LTBI) surveillance in the commercial healthcare sector




Carlson, Erin
Miller, Thaddeus


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Objective: To estimate the prevalence and explore the pattern of TB/LTBI testing and retesting in the commercially insured US population. Domestic TB elimination is a cornerstone of US public health policy, yet progress toward elimination has slowed. One reason for this is the lack of emphasis on identifying and addressing LTBI. Systematic efforts to find and treat persons with active TB or persons with LTBI have defaulted to local and regional public health departments but, given limited resources and murky mandates, LTBI surveillance and treatment by public health is inconsistent. At the same time, TB/LTBI testing is not uncommon in the private sector. Unleveraged synergies exist between the testing conducted by private healthcare providers and the surveillance conducted by public health departments. Understanding the patterns of TB/LTBI screenings conducted in the private sector is a crucial first step toward realizing this potential. Methods: De-identified paid medical claims for services rendered between 4/1/2010 and 3/31/2013 for a sample of 4 million people from the Optum Research Database were analyzed. People in the sample were ages/1/2010 and 3/31/2013. TB/LTBI testing via tuberculin skin testing (TST) and interferon gamma release assay (IGRA) was identified using CPT codes. The index TB/LTBI test per person was identified based on each individual’s first TST or IGRA with a service date between 6/2010 and 5/2011. Subsequent tests were identified based on service dates following the index test through 3/2013. Results: Of the 4 million people, 67,168 (1.68%) had an index TB/LTBI test between 6/2010 and 5/2011. TSTs were more common than IGRAs; 64,788 (96.5%) of index tests were TSTs and 2,355 (3.5%) were IGRAs. Of those with an index TST, 21,645 (33.4%) had another test on a later date. Retesting methods differed depending on how quickly retesting occurred. In patients with a retest within 30 days, 6.4% received an IGRA next instead of another TST, while 2.6% of patients who had a retest in [greater than] 30 days received an IGRA. Conclusion: Much TB/LTBI testing is conducted by providers outside of the US public health system. Data collected by commercial insurers can provide insight into TB/LTBI testing in this setting. These results indicate that TSTs are far more prevalent than IGRAs, but IGRAs are being used in practice for post-TST retesting when retesting is conducted shortly after initial testing.


Research Appreciation Day Award Winner - 2016 School of Public Health and Public Health Student Association - 2nd Place Poster Presentation