Tuberculosis screening for long-term care: a cost-effectiveness analysis.
METHODS
Long-term care facilities in Canada, a low tuberculosis (TB) incidence country.


OBJECTIVE
To compare the impact and cost-effectiveness of three screening strategies for TB on entry to long-term care: no screening, screening for latent tuberculous infection (LTBI) using the tuberculin skin test (TST) or screening for active disease with a chest X-ray.


METHODS
Cost effectiveness analysis.


RESULTS
With the LTBI screening strategy, the number needed to screen to prevent one active case was 1410 and the cost per case averted was Canadian $109 913. The number needed to screen to prevent one case using the active screening strategy was 1266, and the cost per case averted was $672 298.


CONCLUSIONS
Our findings suggest that TB screening strategies on entry to long-term care are costly, with large numbers needed to screen. Screening with TST was more cost-effective than chest X-ray screening. Higher risk of reactivation of LTBI is associated with improved cost-effectiveness of screening. Short time horizons and test performance characteristics place limitations on screening programmes in this setting. Future considerations include the changing demographics of the institutionalised elderly.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. gverma@ualberta.ca
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Verma
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AW
Chuck
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P
Jacobs
D000368:Aged; D000416:Alberta / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006707:Homes for the Aged / Q000191:economics*; D006801:Humans; D015994:Incidence; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000191:economics; D008134:Long-Term Care / Q000191:economics*; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008828:Microbiological Techniques / Q000191:economics; D018803:Models, Economic; D009735:Nursing Homes / Q000191:economics*; D011237:Predictive Value of Tests; D011379:Prognosis; D013902:Radiography, Thoracic / Q000191:economics; D013997:Time Factors; D014374:Tuberculin Test / Q000191:economics; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control