TABLE 4

Cost-Benefit Analysis of School Screening and Associate Investigation Versus Passive Case Finding: 1998–2003

Cost of School ScreeningCost of Associate Investigation
Program costs for screening and treatment for schoolchildren and associates of schoolchildren, $a
    TST testing, wages, and materialsb95187983    
    TB clinic appointmentsc102 44551 086    
    Chest radiographsd12 6455199    
    Interpreterse22632322    
    Total126 87166 590    
    Grand total193 461
Benefits from screening program and associate investigation
    No. of TB cases prevented with school screening25.6
    No. of TB cases prevented with associate investigation10.5
    No. of TB cases prevented, total36.1
Treatment costs, passively diagnosed active TB case, $
    Hospitalized proportion of casef10 848
    Directly observed therapyg1228
    Total cost per case12 076
    Contact investigation (per index case)h694
    Treatment of all contacts (per index case)i2670
    Total cost for 1 active case15 440
Treatment costs based on screening and associate benefits, $
    Treatment of TB cases prevented, school395 264
    Treatment of TB cases prevented, associates162 120
    Treatment of TB cases prevented, total557 384
Total net cost (savings) from school-screening program and associate investigation(363 923)
Total net cost (savings) from school-screening program without associate investigation(268 393)
Total net cost (savings) from associate investigation(95 530)
  • All costs are expressed in Canadian dollars ($1 Canadian = $0.66 US).

  • a Average wages used: $26.40/hour for nurses; $16.00/hour for clerical staff; and $15.50/hour for interpreters.

  • b Based on 6-hour work day for nurses and 3 hours for clerical staff, during which 100 children were screened; another 6 hours for reading results. Materials include syringes, swabs, and printed educational materials.

  • c Includes costs of opening chart, pretreatment consultation, initial physician consultation ($32.60; $47.60 if <5 years old), and 6 follow-up visits.

  • d Chest radiograph cost is $32.49 (for immigrants with papers).

  • e Based on estimated need for interpreter for 1 of 8 patients and billing for 2-hour session.

  • f Includes initial work-up costs ($391), average of 19 days of hospitalization ($13141), and outpatient-therapy costs ($742), based on 76% hospitalization rate.23

  • g Based on 0.75-hour visit with daily visit for first 14 days, followed by twice-weekly visits for a duration of 6 months of therapy: 62 visits.

  • h Based on a local published study.23

  • i Based on a local published study23; 10 contacts per immigrant pediatric active TB case, based on interpolation of data on average number of contacts among ≤18-year-olds and immigrant subgroups in local assessment.24