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Article
Personal and Societal Health Quality Lost to Tuberculosis
PLoS One
  • Thaddeus L. Miller, University of North Texas Health Science Center
  • Peter E. Hilsenrath, University of the Pacific
  • Scott J. N. McNabb, Centers for Disease Control and Prevention
  • Jotam G. Pasipanodya, University of North Texas Health Science Center
  • Stephen E. Weis, University of North Texas Health Science Center
Document Type
Article
DOI
10.1371/journal.pone.0005080
Publication Date
4-8-2009
Abstract
Background: In developed countries, tuberculosis is considered a disease with little loss of Quality-Adjusted Life Years (QALYs). Tuberculosis treatment is predominantly ambulatory and death from tuberculosis is rare. Research has shown that there are chronic pulmonary sequelae in a majority of patients who have completed treatment for pulmonary tuberculosis (PTB). This and other health effects of tuberculosis have not been considered in QALY calculations. Consequently both the burden of tuberculosis on the individual and the value of tuberculosis prevention to society are underestimated. We estimated QALYs lost to pulmonary TB patients from all known sources, and estimated health loss to prevalent TB disease. Methodology/Principal Findings: We calculated values for health during illness and treatment, pulmonary impairment after tuberculosis (PIAT), death rates, years-of-life-lost to death, and normal population health. We then compared the lifetime expected QALYs for a cohort of tuberculosis patients with that expected for comparison populations with latent tuberculosis infection and without tuberculosis infection. Persons with culture-confirmed tuberculosis accrued fewer lifetime QALYs than those without tuberculosis. Acute tuberculosis morbidity cost 0.046 QALYs (4% of total) per individual. Chronic morbidity accounted for an average of 0.96 QALYs (78% of total). Mortality accounted for 0.22 QALYs lost (18% of total). The net benefit to society of averting one case of PTB was about 1.4 QALYs. Conclusions/Significance: Tuberculosis, a preventable disease, results in QALYs lost owing to illness, impairment, and death. The majority of QALYs lost from tuberculosis resulted from impairment after microbiologic cure. Successful TB prevention efforts yield more health quality than previously thought and should be given high priority by health policy makers. (Refer to Abstracto S1 for Spanish language abstract)
Comments
This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
Citation Information
Miller TL, McNabb SJN, Hilsenrath P, Pasipanodya J, Weis SE (2009) Personal and Societal Health Quality Lost to Tuberculosis. PLoS ONE 4(4): e5080. https://doi.org/10.1371/journal.pone.0005080