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Health Department Costs of Managing Persons With Suspected and Noncounted Tuberculosis in New York City, Three Texas Counties, and Massachusetts

Manangan, Lilia P. RN, MPH; Moore, Marisa MD, MPH; Macaraig, Michelle MPH; MacNeil, Jessica MPH; Shevick, Gail MA; Northrup, Jill MPH; Pratt, Robert BS; Adams, Lisa V. MD; Boutotte, Janice PhD, RN; Sharnprapai, Sharon MS; Qualls, Noreen DrPH, MSPH

Journal of Public Health Management and Practice: May-June 2006 - Volume 12 - Issue 3 - p 248–253
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Objectives To describe persons with suspected (did not meet the national tuberculosis [TB] surveillance case definition) and noncounted TB (met the TB case definition but transferred and were counted by another jurisdiction) and estimate costs incurred by public health departments for managing them.

Methods We reviewed TB registry, medical records, budgets, bills, salaries, organizational charts, and travel/activity logs from the year 2000 at health departments in New York City (NYC), three Texas (TX) counties (El Paso, Hidalgo, and Webb), and Massachusetts (MA). We also interviewed or observed personnel to estimate the time spent on activities for these patients

Results In 2000, NYC and MA had more persons with suspected (n = 2,996) and noncounted (n = 163) TB than with counted (n = 1,595) TB. TX counties had more persons with counted TB (n = 179) than with suspected (n = 55) and noncounted (n = 15) TB. Demographic and clinical characteristics varied widely. For persons with suspected TB, NYC spent an estimated $1.7 million, with an average cost of $636 for each person; TX counties spent $60,928 ($1,108 per patient); and MA spent $1.1 million ($3,330 per patient). For persons with noncounted TB, NYC spent $303,148 ($2,180 per patient), TX counties spent $40,002 ($2,667 per patient), and MA spent $84,603 ($3,525 per patient).

Conclusions Health departments incurred substantial costs in managing persons with suspected and noncounted TB. These costs should be considered when allocating TB program resources.

This article describes a retrospective study carried out to estimate costs incurred by public health departments in New York City, three Texas counties, and Massachusetts from managing persons with suspected and noncounted tuberculosis. The article concludes that these costs must be considered when allocating resources for tuberculosis programs.

Lilia P. Manangan, RN, MPH, is an Epidemiologist with the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Marisa Moore, MD, MPH, is a Surveillance Section Chief with the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Michelle Macaraig, MPH, is an Epidemiologist with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York.

Jessica MacNeil, MPH, is an Epidemiologist with the Division of Tuberculosis Control and Prevention, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts.

Gail Shevick, MA, is an Epidemiologist with the Infectious Disease Control Unit, Texas Department of State Health Services, Austin, Texas.

Jill Northrup, MPH, is an Epidemiologist with the Division of Tuberculosis Control and Prevention, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts.

Robert Pratt, BS, is CDC Technology Support Contractor with the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia.

Lisa V. Adams, MD, is Director of Surveillance with the Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York City, New York.

Janice Boutotte, PhD, RN, is Director of Patient Management Services with the Division of Tuberculosis Control and Prevention, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts.

Sharon Sharnprapai, MS, is Director of Tuberculosis Epidemiology and Surveillance with the Division of Tuberculosis Control and Prevention, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts.

Noreen Qualls, DrPH, MSPH, is Health Scientist with the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Corresponding author: Lilia P. Manangan, RN, MPH, Surveillance, Epidemiology, and Outbreak Investigations Branch, Division of Tuberculosis Elimination, CDC, Mail Stop E-10, Atlanta, GA 30333 (e-mail: LManangan@cdc.gov).

We thank the following for their valuable contributions: Tom Navin, MD; Jereb John, MD; Glenda Newell; Mary Masterson, MPA; Cindy R. Driver, RN, MPH; Jessie Brosseau, MPH; Sue Etkind, RN, MPH; John Bernardo, MD; Charles Wallace, MPH, PhD; Gloria Pena, RN, and City of Laredo Health Department; Marie Villa, RN, and El Paso City County Health District; Hidalgo County Health Department; Maria Rodriguez; Jeffery Taylor, MPH; Russell Jones, MPH; Jeffrey Smedley, MPH; Eric Chaparro, BS; and Jeffrey Bennett, BA.

© 2006 Lippincott Williams & Wilkins, Inc.