A comparison of costs of universal versus targeted lead screening for young children

The purposes of this study were to compare universal blood lead screening f or young children versus targeting by a risk assessment questionnaire and t o examine the cost implications of each approach. Costs reflect the total n umber of blood tests required and cost of specimen collection, handling, an d testing per elevated case. The setting included the metropolitan areas of Minneapolis and St. Paul, Minnesota. Children (N = 9603) from 17 community organizations had blood tests. In addition, each child's parent or guardia n completed a questionnaire assessing potential risk for lead poisoning. Fo ur different screening approaches are presented. Each screening approach is presented with associated costs of overall screening and cost per child id entified at blood levels of greater than or equal to 10 mu g/dl (N = 1140) and greater than or equal to 15 mu g/dl (N=317). Based on the screening str ategy selected and an estimate of $17 per blood test, total screening costs ranged from $91,596 to $165,945. The cost per child identified with elevat ed lead levels ranged from $361 to $523 at greater than or equal to 15 and $105 to $146 at greater than or equal to 10. Nine to 13% of children would not have been detected by policies other than universal screening. A geogra phically based approach was able to detect 90% of children with elevated bl ood levels at two-thirds the cost of universal screening. Blood tests would be taken for all children living within city limits. Those residing elsewh ere would be tested only if answers to questionnaire items pertaining to ag e of housing, prior history of lead poisoning, or eating paint chips indica ted risk. The new CDC guidelines suggest that screening be based on an asse ssment of housing, population demographics, and community risk and resource s. This paper presents such an assessment. (C) 1999 Academic Press.