Hospitalizations with TB, California, 2009-2017

BACKGROUND: Hospitalization is a costly event that affects more than half of all TB patients in the United States. State-level hospitalization data are crucial in estimating the cost of TB disease and the financial impact of preventing TB.METHODS: We used California administrative hospital discharge data from 2009 to 2017 to characterize TB hospitalizations in comparison with non-neonatal, non-maternal hospitalizations. TB hospitalization was defined as a hospitalization with a TB ICD-9/10 code as the primary diagnosis. We estimated hospitalization costs in 2017 dollars from reported charges using cost-to-charge ratios.RESULTS: In comparison to persons hospitalized for other conditions, persons hospitalized for TB in 2017 were more likely to be male, of working age, and Asian/Pacific Islander. The median cost for TB hospitalizations was US$22,807 vs. US$11,568 for other hospitalizations. The median length of stay for TB hospitalizations was 12 days compared to 3 days for other hospitalizations. Medicaid was expected to pay for 50% of TB hospitalizations costing US$21,438,208.CONCLUSIONS: Societal cost estimates of TB hospitalization should be updated to reflect long hospital stays and the disproportionate burden on working age persons. This analysis enhances our understanding of the high cost of TB care and underscores the costs averted if TB cases are prevented.