title: Public health costs for tuberculosis suspects in Wake County, North Carolina, United States.
abstract: METHODS
  As the incidence of tuberculosis (TB) declines in high-income countries, resources to control TB are also declining. A portion of these resources are utilized for the evaluation and treatment of persons initially suspected of, but who do not actually have, TB (TB suspects).
  
  
  OBJECTIVE
  To describe the cost of TB suspects to public health departments, and determine whether part of this cost can be averted using improved diagnostic tools.
  
  
  METHODS
  We evaluated resource utilization for all TB suspects as well as a random sample of TB cases managed at the Wake County public health clinic during 2008-2010. The proportion of total health department costs attributable to TB suspects was estimated. A sensitivity analysis assessed the potential impact of a rapid, accurate diagnostic test to avert suspect-associated costs.
  
  
  RESULTS
  Of 135 patients evaluated for TB, 36 (27%) were suspects, accounting for 14% (US5,885) of the total estimated costs for managing all patients. A perfect diagnostic test with a 3-day turnaround would have averted US27,975 (53%) of the costs attributable to suspects.
  
  
  CONCLUSIONS
  A substantial proportion of public health resources is utilized to manage persons whose final diagnosis is not TB. Efficient implementation of novel rapid tests could avert substantial public health costs.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Park
authors.forename: D P
authors.initials: DP
authors.lastname: Holland
authors.forename: A
authors.initials: A
authors.lastname: Wade
authors.forename: N D
authors.initials: ND
authors.lastname: Goswami
authors.forename: D
authors.initials: D
authors.lastname: Bissette
authors.forename: J E
authors.initials: JE
authors.lastname: Stout
mesh_terms: D000328:Adult; D000368:Aged; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D021141:Nucleic Acid Amplification Techniques / Q000191:economics / Q000379:methods; D011634:Public Health / Q000191:economics*; D015980:Public Health Practice / Q000191:economics; D012189:Retrospective Studies; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology