Miniature chest radiograph screening for tuberculosis in jails: a cost-effectiveness analysis

Jails are an important reservoir of tuberculosis infection in the United States. Screening for active disease in these high-risk settings is difficult. We used decision analysis to assess the cost effectiveness of routine miniature chest radiography for screening for tuberculosis on admission to jail. Infection rates, probabilities, and costs associated with detecting and treating tuberculosis were derived from published studies. We calculated an average total cost of $6.60 per inmate for routine radiograph screening on admission to jail. The cost of screening for active tuberculosis with miniature chest radiography was estimated to be $9,600 per case identified, compared with $32,100 per case with tuberculin skin testing and $54,100 per case with symptom screening. Chest radiography would also identify substantially more cases than other methods of screening. Screening for tuberculosis with miniature chest radiography is cost effective even under a wide range of assumptions regarding risk factors and prevalence of disease. Miniature chest radiography should be strongly considered as an important tool in the fight to eliminate tuberculosis from the high-risk populations that may be reached through screening in jails.