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Tuberculin screening: cost-effectiveness analysis of various testing schedules
C B Schechter1, D N Rose, M C Fahs
1Department of Community Medicine, Mt. Sinai School of Medicine, NY 10029.
American Journal of Preventive Medicine
|May 1, 1990
Summary
A single tuberculin screening at age 50 is the most cost-effective strategy for adults. This approach offers a favorable cost-effectiveness ratio, similar to standard health interventions, for preventing tuberculosis.
Area of Science:
- Public Health
- Preventive Medicine
- Health Economics
Background:
- No current recommended tuberculin screening schedule for adults.
- Tuberculosis (TB) remains a significant public health concern requiring effective screening strategies.
Purpose of the Study:
- To determine the optimal cost-effectiveness of adult tuberculin screening schedules.
- To evaluate the impact of various screening frequencies and ages on health outcomes and costs.
Main Methods:
- Markov process modeling for cost-effectiveness analysis.
- Simulation of a black 20-year-old cohort undergoing different screening schedules.
- Inclusion of intradermal tuberculin testing and isoniazid prophylaxis for positive results.
Main Results:
- A single screening at age 50 yielded the lowest cost-effectiveness ratio ($41,672 per QALY gained).
- Single screenings between ages 30-70 showed similar cost-effectiveness; repeated screenings were less effective.
- Screening at age 50 remained optimal under sensitivity analyses, including varying assumptions on isoniazid toxicity.
Conclusions:
- Tuberculin screening at age 50 should be integrated into primary care preventive practices.
- This strategy is cost-effective, comparable to existing health interventions, and robust to parameter variations.
- Future research on isoniazid toxicity may warrant consideration of more frequent screening (e.g., every 10 years) for greater health benefits at a higher cost.
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