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The impact of tuberculosis on health utility: a longitudinal cohort study



To estimate health utility derived from the Short Form-36 (SF-36) questionnaire and Standard Gamble instrument for persons diagnosed and treated for tuberculosis (TB) disease, those diagnosed and treated for latent TB infection (LTBI), and those screened but not treated for TB disease or LTBI over the year following their diagnosis/initial assessment.


Participants were recruited at two Montreal hospitals (2008–2011) and completed the SF-36 and Standard Gamble at baseline and at follow-up visits 1, 2, 4, 6, 9, and 12 months thereafter. SF-6D health utility scores were derived from SF-36 responses. Linear mixed models were used to compare mean health utility at each evaluation and changes in health utility between participants treated for TB disease, those treated for LTBI, and those in the control group.


Of the 263 participants, 48 were treated for TB disease, 105 for LTBI, and 110 were control participants. Fifty-four percent were women, mean age was 35 years, and 90 % were foreign-born. Participants treated for TB disease reported worse health utility compared with control participants at the baseline visit (mean SF-6D: 0.69 vs. 0.81; mean Standard Gamble: 0.64 vs. 0.96). They reported successive improvement at months 1 and 2 that was then sustained throughout follow-up. Health utility reported by participants treated for LTBI and control participants was comparable throughout the study.


Treatment for TB disease had a substantial negative impact on health utility, particularly during the first 2 months of treatment. However, treatment for LTBI did not have a substantial impact.

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  1. Bauer, M., Leavens, A., & Schwartzman, K. (2012). A systematic review and meta-analysis of the impact of tuberculosis on health-related quality of life. Quality of Life Research, 21(10), 1727–1730.

    Article  Google Scholar 

  2. Tuberculosis Coalition for Technical Assistance. (2006). International standards for tuberculosis care (ISTC). The Hague: Tuberculosis Coalition for Technical Assistance.

    Google Scholar 

  3. Public Health Agency of Canada, Canadian Thoracic Society, and the Canadian Lung Association. (2013). Canadian tuberculosis standards (7th ed.)

  4. Menzies, D., Long, R., Trajman, A., Dion, M. J., Yang, J., Al Jahdali, H., et al. (2008). Adverse events with 4 months rifampin or 9 months isoniazid as therapy for latent TB infection: Results of a randomized trial. Annals of Internal Medicine, 149, 689–697.

    Article  PubMed  Google Scholar 

  5. Linas, B. P., Wong, A. Y., Freedberg, K. A., & Horsburgh, C. R, Jr. (2011). Priorities for screening and treatment of latent Tuberculosis infection in the United States. American Journal of Respiratory and Critical Care Medicine, 184(5), 590–601.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Vissandjée, B., Bates, K., Vialla, F., & Kuntz, J. (2013). Expérience d’immigration et droit à la santé, à des soins et à des services de qualité: une question de justice sociale. Revue Internationale de la Recherche Interculturelle Alterstice, 3(1), 67–83.

    Google Scholar 

  7. Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 Physical and Mental Health Summary Scales: A user’s manual. Boston: The Health Institute.

    Google Scholar 

  8. Rossi, C., Zwerling, A., Thibert, L., Rivest, P., McIntosh, F., Behr, M. A., et al. (2012). Mycobacterium tuberculosis transmission over an 11-year period in a low-incidence, urban setting. International Journal of Tuberculosis and Lung Disease, 16, 312–318.

    Article  CAS  PubMed  Google Scholar 

  9. Brazier, J., & Roberts, J. R. (2004). The estimation of a preference-based index from the SF-12. Medical Care, 42(9), 851–859.

    Article  PubMed  Google Scholar 

  10. Brazier, J., Roberts, J. R., & Deverill, M. (2002). The estimation of a preference-based measure of health from the SF-36. Journal of Health Economics, 21, 271–292.

    Article  PubMed  Google Scholar 

  11. Dion, M. J., Tousignant, P., Bourbeau, J., Menzies, D., & Schwartzman, K. (2004). Feasibility and reliability of health-related quality of life measurements among tuberculosis patients. Quality of Life Research, 13, 653–665.

    Article  CAS  PubMed  Google Scholar 

  12. Drummond, M. F., Sculpher, M. J., Torrance, G. W., O’Brien, B. J., & Stoddard, G. L. (2005). Methods for the economic evaluation of health care programmes (3rd ed.). New York: Oxford University Press.

    Google Scholar 

  13. Dion, M. J., Tousignant, P., Bourbeau, J., Menzies, D., & Schwartzman, K. (2002). Measurement of health preferences among patients with tuberculosis infection and disease. Medical Decision Making, 22(Suppl), S102–S114.

    Article  PubMed  Google Scholar 

  14. Fisher, R. A. (1925). Statistical methods for research workers. Edinburgh: Oliver & Boyd.

    Google Scholar 

  15. Pearson, K. (1900). On the criterion that a given system of deviations from the probable in the case of a correlated system of variables is such that it can be reasonably supposed to have arisen from random sampling. Philosophical magazine series 5. doi: 10.1080/14786440009463897

  16. Student, (1908). The probable error of a mean. Biometrika, 6(1), 1–25.

    Article  Google Scholar 

  17. Sloane, J., & Symonds, T. (2001). Health related quality of life: When does a statistically significant change become clinically significant?. Washington, DC: ISOQOL Educational Workshop.

    Google Scholar 

  18. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillside, NJ, USA: Academic Press.

    Google Scholar 

  19. Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York: Oxford University Press.

    Book  Google Scholar 

  20. SAS Institute Inc., SAS statistical software v. 9.3. (2011). Cary, NC, USA.

  21. Microsoft. Microsoft Excel. (2010). Washington, USA: Redmond.

  22. Guo, N., Marra, C. A., Marra, F., Moadebi, S., Elwood, R. K., & Fitzgerald, J. M. (2008). Health state utilities in latent and active tuberculosis. Value in Health, 11(7), 1154–1161.

    Article  PubMed  Google Scholar 

  23. Kruijshaar, M. E., Lipman, M., Essink-Bot, M.-L., Lozewicz, S., Créer, D., Dart, S., et al. (2010). Health status of UK patients with active tuberculosis. The International Journal of Tuberculosis and Lung Disease, 14(3), 296–302.

    CAS  PubMed  Google Scholar 

  24. Hays, R. D., Reeve, B. B., Smith, A. W., & Clauser, S. B. (2013). Associations of cancer and other chronic medical conditions with SF-6D preference-based scores in Medicare beneficiaries. Quality of Life Research. 10.1007/s11136-013-0503-9

  25. Simich, L. (2009). Health literacy and immigrant populations (policy brief).

  26. Menzies, D., Oxlade, O., & Lewis, M. (2006). Costs for tuberculosis care in Canada. Public Health Agency of Canada publications and educational materials. 1–28.

  27. Khanna, D., Yan, X., Tashkin, D. P., Furst, D. E., Elashoff, R., Roth, M. D., et al. (2007). Impact of oral cyclophosphamide on health-related quality of life in patients with active scleroderma lung disease: Results from the Scleroderma Lung Study. Arthritis and Rheumatism, 56, 1676–1684.

    Article  CAS  PubMed  Google Scholar 

  28. McDonald, J. F., & Moffitt, R. A. (1980). The uses of tobit analysis. The Review of Economics and Statistics,. doi:10.2307/1924766.

    Google Scholar 

  29. Twisk, J., & Rijmen, F. (2009). Longitudinal tobit regression: A new approach to analyze outcome variables with floor or ceiling effects. Journal of Clinical Epidemiology, 62, 953–958.

    Article  PubMed  Google Scholar 

  30. Von Hippel, P. T. (2007). Regression with missing ys: An improved strategy for analyzing multiple imputed data. Sociological Methodology,. doi:10.1111/j.1467-9531.2007.00180.x.

    Google Scholar 

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This research was funded by the Canadian Institutes of Health Research (CIHR). M. Bauer was supported by the CIHR-Quebec Respiratory Health Training Program, the Research Institute of the McGill University Health Centre, and the Faculty of Medicine, McGill University.

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The authors do not have any competing interests to declare.

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Correspondence to Kevin Schwartzman.

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Bauer, M., Ahmed, S., Benedetti, A. et al. The impact of tuberculosis on health utility: a longitudinal cohort study. Qual Life Res 24, 1337–1349 (2015).

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