School-based screening for tuberculous infection: A cost-benefit analysis

J. C. Mohle-Boetani, B. Miller, Michael Halpern, A. Trivedi, J. Lessler, S. L. Solomon, M. Fenstersheib

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Objective. - To compare tuberculin screening of all kindergartners and high school entrants (screen-all strategy) vs screening limited to high-risk children (targeted screening). Design. - Decision, cost-effectiveness, and cost-benefit analyses. Setting and Subjects. - Students in a large urban and rural county. Definitions. - 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. Outcome Measures. - Tuberculosis cases prevented per 10 000 children screened. Net costs, net cost per case prevented, benefit-cost ratio, and incremental cost-effectiveness. Results. - The screen-all strategy would prevent 14.9 cases per 10 000 children screened; targeted screening would prevent 84.9 cases per 10 000 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 ($16 392). Conclusions. - Targeted screening of schoolchildren is much less costly than mass screening and is more efficient in prevention of tuberculosis.

Original languageEnglish (US)
Pages (from-to)613-619
Number of pages7
JournalJournal of the American Medical Association
Volume274
Issue number8
StatePublished - 1995
Externally publishedYes

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Cost-Benefit Analysis
Tuberculosis
Infection
Costs and Cost Analysis
Parturition
Contact Tracing
Mass Screening
Tuberculin
Outcome Assessment (Health Care)
Students

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mohle-Boetani, J. C., Miller, B., Halpern, M., Trivedi, A., Lessler, J., Solomon, S. L., & Fenstersheib, M. (1995). School-based screening for tuberculous infection: A cost-benefit analysis. Journal of the American Medical Association, 274(8), 613-619.

School-based screening for tuberculous infection : A cost-benefit analysis. / Mohle-Boetani, J. C.; Miller, B.; Halpern, Michael; Trivedi, A.; Lessler, J.; Solomon, S. L.; Fenstersheib, M.

In: Journal of the American Medical Association, Vol. 274, No. 8, 1995, p. 613-619.

Research output: Contribution to journalArticle

Mohle-Boetani, JC, Miller, B, Halpern, M, Trivedi, A, Lessler, J, Solomon, SL & Fenstersheib, M 1995, 'School-based screening for tuberculous infection: A cost-benefit analysis', Journal of the American Medical Association, vol. 274, no. 8, pp. 613-619.
Mohle-Boetani JC, Miller B, Halpern M, Trivedi A, Lessler J, Solomon SL et al. School-based screening for tuberculous infection: A cost-benefit analysis. Journal of the American Medical Association. 1995;274(8):613-619.
Mohle-Boetani, J. C. ; Miller, B. ; Halpern, Michael ; Trivedi, A. ; Lessler, J. ; Solomon, S. L. ; Fenstersheib, M. / School-based screening for tuberculous infection : A cost-benefit analysis. In: Journal of the American Medical Association. 1995 ; Vol. 274, No. 8. pp. 613-619.
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