Cost effectiveness analysis of school based Mantoux screening for TB infection.
OBJECTIVE
To assess the cost-effectiveness of adding school based Mantoux screening programs to the New South Wales current TB prevention strategy.


METHODS
A decision analysis model compared the costs and consequences of screening strategies against the current no-screen strategy. Costs associated with screening and with treating future cases of TB were considered. Consequences considered were deaths and adult cases of TB prevented. The study was based on data from prevalence surveys conducted in 1992 and 1994 in Central and South Western Sydney, New South Wales. Screening strategies considered were screening all or only overseas born (OSB) 6 year olds and all or only OSB 14 year olds in school settings.


RESULTS
Screening 14 year olds prevented more deaths and adult cases of TB than screening 6 year olds for a similar cost. For both age groups targeted screening of OSB children was more cost-effective than screening all children. Targeted screening of 14 year olds--the most cost effective option--cost $17,956 (costs and benefits discounted at 5%) per adult case prevented, equivalent to approximately $130,000 per life year saved. The cost-effectiveness ratios decline substantially if lower discount rates and less conservative assumptions are applied.


CONCLUSIONS
Targeted screening was more cost effective than screening all children, however, there are ethical implications of targeting a group based on their origin of birth.


CONCLUSIONS
As prevention and control of TB continues to be a high priority for NSW, the implications of a school based screening program should be seriously considered.
Centre for Health Economics, Research and Evaluation, University of Sydney, New South Wales.
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A
Lowin
J
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Slater
J
J
Hall
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Alperstein
D000293:Adolescent; D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D003662:Decision Theory; D006302:Health Services Research; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009517:New South Wales / Q000453:epidemiology; D012572:School Health Services / Q000191:economics*; D014374:Tuberculin Test / Q000191:economics / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000517:prevention & control