Cost effectiveness of screening for tuberculosis in a general medical clinic

Over a 3-year period, only 22 new active cases of tuberculosis were discovered as a result of taking 48,000 70-mm X-ray films of generally elderly and chronically ill patients. The cases were among the patients of the general medical outpatient clinic of Grady Memorial Hospital in Atlanta, Ga. Costs for the X-ray screening program exceeded $90,000. Ten of the 22 patients with new cases were alcohol abusers. Further analysis of the program revealed a yield of 1 new active case per 240 alcoholics screened, but only 1 new active case per 3,806 nonalcoholic patients screened. It is argued that screening of alcoholics for tuberculosis should be widely practiced, but routine yearly X-rays for detection of tuberculosis--even in a chronically ill population--is unwarranted.