Tuberculosis Prevention and Control

Publications and Educational Materials

Costs for Tuberculosis Care in Canada

Copyright 2006 D. Menzies MD

PDF Version

A report prepared by Dick Menzies MD MSc,
Olivia Oxlade MSc and Megan Lewis BSc
for the Public Health Agency of Canada.

Table of Contents

• Abstract
• Introduction
• Objectives
• Methods
  • Synopsis
  • Sampling and selection of jurisdictions
    • Federal
    • Provincial/Territorial
    • Local Departments of Health
    • Clinics
  • Approach
  • Missing Values
    • Active cases
  • Calculations
  • Final estimation of costs
• Results
  • Participating institutions
• Discussion
• Conclusions
• Tables
  • Table 1: Additional sources of information utilized
  • Table 2: Cost of TB drugs and typical treatment for active and latent TB infection (LTBI)
  • Table 3: Estimated numbers and costs for TST screening in health care workers, and students in Canada
  • Table 4: Current funding for TB related research in Canada
  • Table 5: Total TB care activities at different jurisdictional levels
  • Table 6: Total full-time equivalent Public Health staff, and salaries, for TB related activities by jurisdiction (Excludes the four hospital clinics)
  • Table 7: Breakdown of costs by TB control activity (excludes all research funding or other federal contributions. Also excludes FNIHB contributions)
  • Table 8: Total government expenditures by jurisdictional level
  • Table 9: Regional spending on TB in 2004
    

Abstract

Background – As tuberculosis (TB) incidence declines in Canada the TB control efforts and therefore expenditures must be increasingly focused on high risk subgroups. However actual current expenditures are unknown. We conducted a survey to estimate the tuberculosis (TB) related expenditures by governments and other third parties in Canada in 2004.

Methods – A direct self-administered questionnaire was mailed to all federal departments with involvement in TB, TB control departments in all 10 provinces and 3 northern territories as well as all provincial or regional TB laboratories. Hospitalization information was obtained from the Canadian Institute for Health Information; costs for care were derived from published literature. Direct and indirect patient paid costs were not included. All costs were ascertained for 2004 and expressed in Canadian dollars.

Results – In 2004, total TB related expenditures in Canada were $74 million, equivalent to $47,290 for every active TB case diagnosed in that year. Research accounted for $4.5 million (or 6% of the total). Non-research related federal spending accounted for $16.3 million (22%) and provincial/territorial expenditures accounted for $53 million (72%). Active tuberculosis accounted for 60% of provincial/territorial expenditures. There were substantial regional differences in TB related expenditures with the highest expenditures in the northern territories, and lowest in the Atlantic provinces. These differences likely reflect differences in accessibility of the populations to health care services, and need for greater interventions in communities at increased risk of tuberculosis with ongoing transmission.

Conclusions – Total TB related expenditures in Canada in 2004 were considerable and, at $47,290 per active case, are higher than previous estimates. However these expenditures are similar to other published estimates of total government spending in other high-income countries.

Introduction

Tuberculosis (TB) has proven to be a difficult disease to eliminate. Although incidence in Canada declined throughout most of the 20th century and continues to decline slightly each year in the new millennium, there were provisionally 1,574 active cases of tuberculosis in 2004. This represents a reduction of 7.6% over the previous three years. This slow decline has been noted in many other high income countries - despite intensive control efforts and substantial expenditures at many levels. Indeed it would not be surprising that as incidence declined, expenditures per case would increase.

However, the level of expenditures for TB care and prevention in Canada is unknown. This is because TB is the responsibility of many different government jurisdictions. In Canada the federal, provincial, territorial, county and municipal governments are all involved in different aspects of TB care. In addition care is provided by hospitals, clinics, and individual providers – outside of the traditional public health system. Adding to the complexity are the diverse populations affected by TB – including aboriginals, elderly, homeless and other urban poor, and immigrants.

Costs for TB care were estimated in the United States in the early 1990's by the Centers for Disease Control and Prevention. However, a comprehensive survey of TB costs has never been conducted in Canada. The slowing decline in the TB incidence rate suggests that additional interventions may be needed. Therefore, it seems timely to examine what is currently spent for tuberculosis (TB) care and prevention, and how it is spent at the present time.

Objectives

1. Estimate total spending for TB, by governments and other third party providers in Canada
2. Examine regional differences as well as spending by different jurisdictions. Examine the impact of number of cases as well as geographic dispersion on expenditures per case
3. Calculate the cost for specific activities such as care of active TB, latent TB infection and contact investigations