• Yunfei Li, Suzanne M Marks, Garrett R Beeler Asay, Carla A Winston, Dawn Pepin, Susan McClure, Nicole A Swartwood, Ted Cohen, C Robert Horsburgh, Joshua A Salomon, and Nicolas A Menzies.
• Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Y.L., N.A.S.).
• Ann. Intern. Med. 2025 Feb 7.

BackgroundIn the United States, older adults have elevated prevalence of latent tuberculosis infection (LTBI) and incidence of tuberculosis (TB).ObjectiveTo estimate the health benefits and cost-effectiveness of LTBI testing and treatment among the Medicare-eligible population.DesignModel-based cost-effectiveness analysis.Data SourcesNationally representative surveys and published evidence.Target PopulationMedicare-eligible persons aged 65 years or older with at least 1 of 15 factors associated with elevated TB risk, as identified by guidelines from the U.S. Preventive Services Task Force (USPSTF) and other organizations.Time HorizonLifetime.PerspectiveSocietal.InterventionOne-time offer of LTBI testing and treatment versus no intervention.Outcome MeasuresLifetime TB cases and deaths averted, quality-adjusted life-years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs).Results Of Base Case AnalysisIn 2022, there were an estimated 29.9 million Medicare-eligible persons (95% uncertainty interval [UI], 28.4 to 31.6 million persons) aged 65 years or older with elevated TB risks, including 14.7 million (95% UI, 13.4 to 16.0 million) with USPSTF-recommended factors. In the target population, 4.9 million persons (95% UI, 4.0 to 5.8 million persons) (16.4% [95% UI, 13.9% to 19.1%]) were estimated to have LTBI. Testing and treatment of LTBI was estimated to prevent 10 946 TB cases (95% UI, 4684 to 20 579 cases) and 2579 TB deaths (95% UI, 1106 to 4882 deaths), with 13 234 lifetime QALYs (95% UI, 5343 to 25 519 lifetime QALYs) gained. For the overall target population and for persons with USPSTF-recommended factors, ICERs were $192 000 (95% UI, $92 000 to $503 000) and $155 000 (95% UI, $77 000 to $393 000) per QALY gained, respectively.Results Of Sensitivity AnalysisThe ICER was $109 000 (95% UI, $49 000 to $285 000) per QALY gained for 65-year-olds newly eligible for Medicare.LimitationHealth benefits from averted post-TB sequelae were not estimated.ConclusionMedicare-eligible persons represent approximately one third of all U.S. persons with LTBI. Testing and treatment of LTBI in this population could lead to substantial reductions in TB and TB-related mortality, particularly among 65-year-olds newly eligible for Medicare.Primary Funding SourceCenters for Disease Control and Prevention.

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