This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Mary D. Nettleman, MD, MS; Heidi Geerdes; Marie-Claude Roy, MD

Arch Intern Med. 1997;157(10):1121-1127.

Abstract
Background
Tuberculin skin testing using the purified protein derivative is recommended as part of a tuberculosis control program for health care workers. However, compliance with skin testing programs has been poor and their cost-effectiveness is unknown.

Methods
A Markov-based decision analysis was performed to determine the cost-effectiveness of tuberculin skin testing over the entire lifetimes of physicians who are now in medical school. Assumptions were deliberately chosen to present a conservative estimate of cost-effectiveness. Indirect costs were not included.

Results
Annual testing cost $29 000 per life-year saved and $39 000 per case of pulmonary tuberculosis prevented. In contrast, particulate respirators have been shown to cost millions of dollars per case prevented. Skin testing every 6 months was cost-effective in a subpopulation at high risk of infection (1.8-fold). During their entire lifetimes, physicians now in medical school can expect to avert 137 cases of pulmonary tuberculosis, prevent 7 tuberculosis deaths, and save 182 life-years because of skin testing programs. Improved compliance with annual skin testing and prophylactic isoniazid could more than triple this benefit. If available, a moderately effective vaccine would be even more cost-effective than tuberculin skin testing programs.

Conclusions
Tuberculin skin testing is cost-effective and should be an integral part of any tuberculosis control program. Vaccination may one day be a feasible and cost-effective alternative to skin testing programs.

Arch Intern Med. 1997;157:1121-1127

Author Affiliations
From the Department of Internal Medicine, Virginia Commonwealth University, Richmond (Dr Nettleman), and University of Iowa College of Medicine, Iowa City (Ms Geerdes and Dr Roy).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Factors Associated With the Treatment of Latent Tuberculosis Infection Among Health-Care Workers at a Midwestern Teaching Hospital
Shukla et al.
Chest 2002;122:1609-1614.
ABSTRACT | FULL TEXT