Published online July 2, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. 90-99 (doi:10.1542/peds.2006-2168)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Flaherman, V. J.
Right arrow Articles by Royce, S. E.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Flaherman, V. J.
Right arrow Articles by Royce, S. E.
Related Collections
Right arrow Infectious Disease & Immunity

ARTICLE

Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry

Valerie J. Flaherman, MD, MPHa, Travis C. Porco, PhD, MPHb, Elliot Marseille, PhD, MPPc and Sarah E. Royce, MD, MPHb

a Department of Pediatrics, University of California, San Francisco, California
b California Department of Health Services, Richmond, California
c Health Strategies International, Orinda, California

OBJECTIVE. We undertook a decision analysis to evaluate the economic and health effects and incremental cost-effectiveness of using targeted tuberculin skin testing, compared with universal screening or no screening, before kindergarten.

METHODS. We constructed a decision tree to determine the costs and clinical outcomes of using targeted testing compared with universal screening or no screening. Baseline estimates for input parameters were taken from the medical literature and from California health jurisdiction data. Sensitivity analyses were performed to determine plausible ranges of associated outcomes and costs. We surveyed California health jurisdictions to determine the prevalence of mandatory universal tuberculin skin testing.

RESULTS. In our base-case scenario, the cost to prevent an additional case of tuberculosis by using targeted testing, compared with no screening, was $524897. The cost to prevent an additional case by using universal screening, compared with targeted testing, was $671398. The incremental cost of preventing a case through screening remained above $100000 unless the prevalence of tuberculin skin testing positivity increased to >10%. More than 51% of children entering kindergarten in California live where tuberculin skin testing is mandatory.

CONCLUSIONS. The cost to prevent a case of tuberculosis by using either universal screening or targeted testing of kindergarteners is high. If targeted testing replaced universal tuberculin skin testing in California, then $1.27 million savings per year would be generated for more cost-effective strategies to prevent tuberculosis. Improving the positive predictive value of the risk factor tool or applying it to groups with higher prevalence of latent tuberculosis would make its use more cost-effective. Universal tuberculin skin testing should be discontinued, and targeted testing should be considered only when the prevalence of risk factor positivity and the prevalence of tuberculin skin testing positivity among risk factor–positive individuals are high enough to meet acceptable thresholds for cost-effectiveness.

Key Words: tuberculosis • cost-effectiveness • school health services • mass screening • tuberculin test

Abbreviations: TST—tuberculin skin testing • TT—targeted tuberculin skin testing • PTCG—Pediatric Tuberculosis Collaborative Group • RQ—risk factor questionnaire • QALY—quality-adjusted life year • BESS—Medicare Part B Extract Summary System

Accepted Feb 28, 2007.




This article has been cited by other articles:


Home page
 PediatricsHome page
M. N. Lobato, J. A. Jereb, and J. R. Starke
Unintended Consequences: Mandatory Tuberculin Skin Testing and Severe Isoniazid Hepatotoxicity
Pediatrics, June 1, 2008; 121(6): e1732 - e1733.
[Abstract] [Full Text] [PDF]