Tuberculosis prevention versus hospitalization: taxpayers save with prevention.

This study describes who pays for inpatient tuberculosis (TB) care and factors associated with payer source. The authors analyzed TB hospitalization costs for a prospective cohort of active TB patients at 10 U.S. sites. Private insurance paid for 9 percent and private hospitals for 6 percent of TB hospitalization costs. Public sources (federal, state, and local governments and public hospitals) paid more than 85 percent of TB hospitalization costs. Preventive services (treatment for latent TB infection; housing, food, and social work for homeless persons; substance abuse treatment for substance abusers; and antiretroviral medication for HIV-infected persons) targeted to those at high risk for TB hospitalization could save taxpayers between $4 million and $118 million. Since public resources are used to pay nearly all the costs of late-stage TB care, the public sector could save by shifting resources currently used for inpatient care to target preventive services to persons at high risk for TB hospitalization.