COMMUNITY-BASED TUBERCULIN SCREENING IN MONTREAL - A COST-OUTCOME DESCRIPTION

Objectives. This study describes the costs and outcomes of community-b ased tuberculin screening programs conducted between 1987 and 1991 in Montreal, Quebec, Canada. Methods. Follow-up information was abstracte d from hospital records of all reactors detected in tuberculin screeni ng of students in grades 6 and 10, of first-year health professional s tudents, and of workers aged 18 to 25 in a number of workforces. Scree ning costs were estimated directly from survey records, and follow-up costs were estimated from the annual financial report of the Montreal Chest Hospital for 1989/90. Results. Of 7669 persons tested, 782 (10.2 %) had positive results and 757 (9.9%) were referred to a clinic. Of t hose, 525 (6.8% of the original 7669) reported, 293 (3.8%) were prescr ibed therapy, and 154 (2.0%) were compliant. In Canadian dollars, scre ening cost $5.70 per person tested and $56 per tuberculin reactor dete cted, but follow-up of reactors accounted for 73% of the total program cost of $13 455 to $18 753 per case of tuberculosis prevented. Conclu sions. Because of high rates of patient and provider noncompliance, a tuberculin screening program was much less cost-effective than anticip ated. Screening costs must be targeted to the highest risk populations , and compliance with recommendations for preventive therapy must be m aximized.