Cost-effectiveness analysis of lead poisoning screening strategies following the 1997 guidelines of the Centers for Disease Control and Prevention

Objective: To compare blood lead (BPb) poisoning screening strategies in li ght of the 1997 recommendations by the Centers for Disease Control and Prev ention, Atlanta, Ga. Design: Cost-effectiveness analysis from the perspective of the health care system to compare the following 4 screening strategies: (1) universal scre ening of venous BPb levels; (2) universal screening of capillary BW levels; (3) targeted screening of venous BPb levels for those at risk; and (4) tar geted screening of capillary BPb levels for those at risk; Costs of follow- up testing and treatment were included in the model. Results: Only universal venous screening detected all BPb levels of at leas t 0.48 mu mol/L (10 mu g/dL). Universal capillary screening detected betwee n 93.2% and 95.5% of cases, depending on the prevalence of elevated BPb lev els. Targeted screening was the least sensitive strategy for detecting case s. Venous testing identified between 77.3% and 77.9% of cases, and capillar y testing detected between 72.7% and 72.8% of cases. In high-prevalence pop ulations, universal venous screening minimized the cost per case ($490). In low- and medium-prevalence populations, targeted screening using venous te sting minimized the cost per case ($729 and $556, respectively). In all pop ulations, regardless of screening strategy, venous testing resulted in a lo wer cost per case than capillary testing. Sensitivity analyses of all param eters in this model demonstrated that this conclusion is robust. Conclusions: Universal. screening detects all cases of lead poisoning and i s the most cost-effective strategy in high-prevalence populations. In popul ations with lower prevalence, the cost per case detected using targeted scr eening is less than that of universal screening. The benefit of detecting a greater number of cases using universal screening must be weighed against the extra cost of screening. Regardless of whether a strategy of universal or targeted screening is used, the cost per case using venous testing is le ss than that of capillary testing.