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A comparison of costs of universal versus targeted lead screening for young children
S J Rolnick1, J Nordin, L M Cherney
1Group Health Foundation, HealthPartners, Minneapolis, Minnesota.
Insights
Targeted blood lead screening for children using risk assessments is more cost-effective than universal screening. A geographically based approach identified 90% of elevated blood lead levels at two-thirds the cost.
Area of Science:
- Pediatric Environmental Health
- Public Health Policy
- Toxicology
Background:
- Childhood lead poisoning remains a significant public health concern.
- Current screening methods for blood lead levels (BLLs) vary in effectiveness and cost.
- Assessing risk factors is crucial for efficient lead poisoning prevention strategies.
Purpose of the Study:
- To compare universal blood lead screening versus risk assessment questionnaires for young children.
- To analyze the cost implications of different blood lead screening approaches.
- To evaluate screening strategies aligned with new CDC guidelines.
Main Methods:
- Conducted blood lead level (BLL) testing for 9603 children across 17 community organizations.
- Administered risk assessment questionnaires to parents/guardians to identify potential lead poisoning risk factors.
- Modeled four distinct screening approaches, calculating overall costs and cost per elevated case (>/=10 and >/=15 microg/dl).
Main Results:
- Total screening costs ranged from $91,596 to $165,945, with cost per elevated case between $105-$146 (>/=10 microg/dl) and $361-$523 (>/=15 microg/dl).
- Universal screening missed 9-13% of children with elevated BLLs.
- A geographically based approach identified 90% of elevated BLLs at two-thirds the cost of universal screening.
Conclusions:
- Targeted screening strategies, particularly geographically based approaches, offer a more cost-effective alternative to universal blood lead screening.
- Risk assessment questionnaires and geographic data can guide efficient screening, aligning with current public health recommendations.
- Optimizing screening methods is essential for maximizing lead poisoning detection while minimizing healthcare expenditures.
Abstract:
The purposes of this study were to compare universal blood lead screening for young children versus targeting by a risk assessment questionnaire and to examine the cost implications of each approach. Costs reflect the total number of blood tests required and cost of specimen collection, handling, and testing per elevated case. The setting included the metropolitan areas of Minneapolis and St. Paul, Minnesota. Children (N=9603) from 17 community organizations had blood tests. In addition, each child's parent or guardian completed a questionnaire assessing potential risk for lead poisoning. Four different screening approaches are presented. Each screening approach is presented with associated costs of overall screening and cost per child identified at blood levels of >/=10 microg/dl (N=1140) and >/=15 microg/dl (N=317). Based on the screening strategy selected and an estimate of $17 per blood test, total screening costs ranged from $91,596 to $165,945. The cost per child identified with elevated lead levels ranged from $361 to $523 at >/=15 and $105 to $146 at >/=10. Nine to 13% of children would not have been detected by policies other than universal screening. A geographically based approach was able to detect 90% of children with elevated blood levels at two-thirds the cost of universal screening. Blood tests would be taken for all children living within city limits. Those residing elsewhere would be tested only if answers to questionnaire items pertaining to age of housing, prior history of lead poisoning, or eating paint chips indicated risk. The new CDC guidelines suggest that screening be based on an assessment of housing, population demographics, and community risk and resources. This paper presents such an assessment.
