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1, 2008
No. 1, 2008
Clinical and Health Systems Research Branch
Update
A New Resource to Help Employers Prevent TB
In 2005, the National Business Group on Health began collaborating
with CDC to produce
A Purchasers Guide to Clinical Preventive
Services: Moving Science into Coverage. The document, which became
available in December 2006 both electronically and in hard copy,
provides scientific evidence and clinical guidelines for effective
ways to prevent illness and premature death from 46 conditions,
including TB. The Guide is designed to help employers select and
implement clinical preventive services.
The National Business Group on Health is a national non-profit
association of 265 companies (many in the Fortune 500) interested in
addressing its members’ provision-of-health-care issues. These
businesses provide health care coverage, often through
self-insurance mechanisms, for 50 million U.S. workers, retirees,
and their families. Among the association’s members are Wal-mart,
which is the nation’s largest employer (over 1 million low-income
workers), and other employers in industries such as poultry
processing, casinos/entertainment, communications / electronics /
computer, hospitality, automobile manufacturing, oil and gas, fast
food, and discount retail businesses. These employers often hire
substantial numbers of persons who may be at high risk for TB,
including many from countries of high TB prevalence.
Within the Purchasers’ Guide, for each condition there is a
scientific evidence statement that includes information about the
- Prevalence and/or incidence of the condition,
- Risk factors associated with the condition,
- Economic burden of the condition and the economic benefit of early
identification/intervention,
- Cost-benefit/cost-effectiveness of the recommended preventive
intervention,
- Cost of the recommended intervention,
- Purpose of the recommended intervention, and
- Benefits and risks of the recommended intervention.
Each condition’s clinical guidelines statement contains the covered
screening procedures, periodicity for screening initiation and
cessation, and Current Procedural Terminology (CPT) codes to
facilitate the implementation and reimbursement of clinical
preventive service benefits.
The TB clinical guidelines and evidence statements were derived from
published CDC documents, such as the targeted testing, infection
control, TB treatment, TB control, and contact investigation
guidelines. In the document, CDC recommends targeted testing of
persons at high risk for TB to identify and treat those found to
have latent TB infection (LTBI) or TB. High-risk persons are defined
as those who have had recent TB exposure, have a positive reaction
to the tuberculin skin test (TST) or an interferon gamma release
assay (IGRA) such as the QuantiFERON-TB Gold test), have had TB in
the past, are immunosuppressed (including having HIV infection), are
substance abusers, were born in a region of high TB-prevalence, are
a low-income minority, reside in or are employed in a high-risk
congregate setting, are health care workers who serve high-risk
persons, or have a persistent cough for 2-3 weeks plus one
additional TB symptom. Screening for TB is considered a covered
benefit. For TB diagnosis, coverage may include use of chest
radiographs, sputum induction, or mycobacterial smears and cultures.
For LTBI, coverage may include use of the TST or an approved IGRA
test.
The document also presents the scientific evidence for the value of
preventing TB. Published articles summarize the burden of TB in the
United States in terms of numbers of hospitalizations, inpatient
days, and direct medical costs of TB care. Estimated costs of an
LTBI screening and treatment effort are also provided.
Feedback since the document’s release suggests that it has been well
received by the association’s members. It is hoped that the
inclusion of tuberculosis in this guide will lead to improvements in
screening, testing, and care for TB and LTBI among employees in the
association’s industries.
The entire 494-page document is available for free
.A Purchasers Guide to Clinical Preventive
Services: Moving Science into Coverage. About halfway down the page is
Condition Specific Information, which lists all 46 of the conditions
in alphabetical order.
Last Updated:
07/01/2008
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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