title: Using cost and health impacts to prioritize the targeted testing of tuberculosis in the United States.
abstract: OBJECTIVE
  Evaluation improves efficiency and effectiveness. Current U.S. tuberculosis (TB) control policies emphasize the treatment of latent TB infection (LTBI). However, this policy, if not targeted, may be inefficient. We determined the efficiency of a state-law mandated TB screening program and a non state-law mandated one in terms of cost, morbidity, treatment, and disease averted.
  
  
  METHODS
  We evaluated two publicly funded metropolitan TB prevention and control programs through retrospective analyses and modeling. Main outcomes measured were TB incidence and prevalence, TB cases averted, and cost.
  
  
  RESULTS
  A non state-law mandated TB program for homeless persons in Tarrant County screened 4.5 persons to identify one with LTBI and 82 persons to identify one with TB. A state-law mandated TB program for jail inmates screened 109 persons to identify one with LTBI and 3274 persons to identify one with TB. The number of patients with LTBI treated to prevent one TB case was 12.1 and 15.3 for the homeless and jail inmate TB programs, respectively. Treatment of LTBI by the homeless and jail inmate TB screening programs will avert 11.9 and 7.9 TB cases at a cost of 14,350 US dollars and 34,761 US dollars per TB case, respectively.
  
  
  CONCLUSIONS
  Mandated TB screening programs should be risk-based, not population-based. Non mandated targeted testing for TB in congregate settings for the homeless was more efficient than state-law mandated targeted testing for TB among jailed inmates.
authors.affiliation: Department of Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, USA.
authors.forename: Thaddeus L
authors.initials: TL
authors.lastname: Miller
authors.forename: Peter
authors.initials: P
authors.lastname: Hilsenrath
authors.forename: Kristine
authors.initials: K
authors.lastname: Lykens
authors.forename: Scott J N
authors.initials: SJ
authors.lastname: McNabb
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Moonan
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Weis
mesh_terms: D003365:Costs and Cost Analysis; D006292:Health Priorities; D006301:Health Services Needs and Demand; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000331:legislation & jurisprudence; D011329:Prisoners / Q000706:statistics & numerical data; D013781:Texas; D014374:Tuberculin Test / Q000191:economics*; D014376:Tuberculosis / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States