Tuberculosis control strategies: the cost of particulate respirators.
OBJECTIVE
To assess the cost of the mandatory use of high-efficiency particulate respirators to treat patients with known or suspected tuberculosis.


METHODS
A questionnaire was used to determine the number of high-efficiency particulate respirators required and the number of cases of tuberculosis in employees that could potentially be prevented. Indirect costs included the training and fitness testing of employees. The clinical efficacy of respirators is not known. To provide a best-case scenario, it was assumed that the respirators could prevent as many as 25% of tuberculosis cases in health care workers.


METHODS
159 acute care facilities administered by the Department of Veterans Affairs.


METHODS
Quality improvement, infection control, and employee health specialists.


METHODS
Cost of the respirators compared with their maximum predicted efficacy.


RESULTS
The use of the respirators would cost $7 million per case of tuberculosis prevented and $100 million per life saved.


CONCLUSIONS
High-efficiency particulate respirators are a costly means of trying to prevent tuberculosis. Costs could be reduced by reusing masks or by restricting the number of health care workers allowed to have contact with potentially infectious patients. As the health care budget undergoes further restrictions, specific means of accommodating the cost of new regulations must be found.
Nettleman
M D
MD
Iowa City Veterans Affairs Medical Center, Iowa.
Fredrickson
M
M
Good
N L
NL
Hunter
S A
SA
D003362:Cost-Benefit Analysis; D006787:Hospitals, Veterans; D006801:Humans; D008397:Masks / Q000191:economics; D009784:Occupational Diseases / Q000517:prevention & control*; D010564:Personnel, Hospital; D012134:Respiratory Protective Devices / Q000191:economics*; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control* / Q000635:transmission; D014481:United States