Economic modeling and analysis can facilitate evidence-based policy and practice. Such analyses may exceed the technical capacity and mission of public health agencies, yet may be critical to sustain health protections such as tuberculosis (TB) control. The net effect of TB prevention is incompletely understood, hampering objective value judgments of national TB elimination policies. This may promote inefficiencies and threaten individual and public health protections.

We describe how a HRSA-funded Texas Public Health Training Center (TPHTC) coordinated specialized analytical skills with the needs of a state public health department to create a user-friendly tool to inform planning and resource allocation; and to identify risks, benefits, opportunities, and value in the context of Texas’ Department of State Health Services (TDSHS) TB control programs.


Key informants within TDSHS and faculty from the University of North Texas Health Science Center (UNTHSC) and its associated TPHTC collaborated to develop a combined health, cost, and outcome model to answer questions of interest to TDSHS. The model incorporates standard techniques, TB specific logic and data, and Texas specific population, epidemiologic, and programmatic data into a Microsoft Excel platform. Outcome measures include 2013 USD costs from a public agency perspective and health losses denominated in Quality Adjusted Life Years (QALYs) (but not assigned a dollar value). Outcomes represent the 10-year accrued net present value (NPV) of variable costs associated with each incident TB case. The model used only publicly available, non-confidential data.


Under current public TB prevention and control practices we estimate public spending for acute medical care and health losses for Texas’ 1325 TB cases in 2011 will exceed a NPV $100,000,000 and 4800 QALYs by 2022; societal costs would likely be much higher. Public TB control is relatively cost effective and preserves 3.7 QALYs/case averted at $54,000/QALY.


Partnerships between academic institutions and public health departments offer the potential to produce the economic analyses needed for judicious use of public resources. We used accessible methods, data, and technology to create a model to analyze the relative value of public TB control in Texas as well as to identify potential efficiencies within activities. Our analysis suggests public efforts against latent TB infection effectively and efficiently mitigate some of the substantial health and cost impact of TB to Texas. Most of TB’s burden remains, however, and more careful targeting of prevention by risk promises rich rewards.