title: Economics of United States tuberculosis airline contact investigation policies: a return on investment analysis.
abstract: BACKGROUND
  In 2011, the Centers for Disease Control and Prevention modified its 2008 protocol for flight-related tuberculosis contact investigation initiation. The 2011 Modified protocol was implemented and replaced the 2008 CDC protocol based on comparative epidemiologic and economic analyses; this publication reports the economic analysis results.
  
  
  METHODS
  A return on investment model compared relative changes in tuberculosis disease treatment costs resulting from expenditures on tuberculosis contact investigations and latent tuberculosis infection treatment for the 2008 CDC and Modified protocols.
  
  
  RESULTS
  At moderate/high rates of latent tuberculosis infection and tuberculosis disease, positive returns on investment indicated each $1.00 spent on tuberculosis contact investigations and latent tuberculosis treatment resulted in more than $1.00 of savings from reduced tuberculosis disease treatment costs. Low rates of latent tuberculosis infection and tuberculosis disease resulted in negative returns on investment, indicating economic losses from tuberculosis disease treatment costs. There were smaller economic losses at low latent tuberculosis infection and tuberculosis disease rates with the Modified protocol in comparison to the 2008 CDC protocol, while both identified comparable numbers of persons at risk for tuberculosis.
  
  
  CONCLUSIONS
  The Modified protocol for conducting flight-related tuberculosis contact investigations represents a better use of resources and protects public health.
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, USA. Electronic address: mcoleman@cdc.gov.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Coleman
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Marienau
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Marano
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, USA.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Marks
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, USA.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Cetron
mesh_terms: D064870:Air Travel; D016358:Contact Tracing / Q000191:economics* / Q000379:methods*; D006801:Humans; D055985:Latent Tuberculosis; D012306:Risk; D014376:Tuberculosis / Q000191:economics* / Q000453:epidemiology / Q000635:transmission*; D014481:United States / Q000453:epidemiology
keywords: Contact tracing; Return on investment; Tuberculosis