School-based screening for tuberculous infection
Mohle-Boetani, J. C., Miller, B., Halpern, M., Trivedi, A., Lessler, J., Solomon, S. L., & Fenstersheib, M. (1995). School-based screening for tuberculous infection. JAMA, 274(8), 613-619.
—To compare tuberculin screening of all kindergartners and high school entrants (screen-all strategy) vs screening limited to high-risk children (targeted screening).
—Decision, cost-effectiveness, and cost-benefit analyses.
Setting and Subjects.
—Students in a large urban and rural county.
—High risk of tuberculous infection was defined as birth in a country with a high prevalence of tuberculosis. Low risk was defined as birth in the United States.
—Tuberculosis cases prevented per 10000 children screened. Net costs, net cost per case prevented, benefit-cost ratio, and incremental cost-effectiveness.
—The screen-all strategy would prevent 14.9 cases per 10 000 children screened; targeted screening would prevent 84.9 cases per 10000 children screened. The screen-all strategy is more costly than no screening; the benefit-cost ratio is 0.58. Targeted screening would result in a net savings; the benefit-cost ratio is 1.2. Screening all children is cost saving only if the reactor rate is 20% or greater. The cost per additional case prevented for screening all children compared with targeted screening ($34 666) is more than twice as high as treatment and contact tracing for a case of tuberculosis ($16392).
—Targeted screening of schoolchildren is much less costly than mass screening and is more efficient in prevention of tuberculosis.