Cost-effectiveness of screening compared to case-finding approaches to tuberculosis in long-term care facilities for the elderly

Background To determine if the more interventionist approach of screening w ith the tuberculin test and chemoprophylaxis for high-risk positive reactor s to control tuberculosis in long-term care facilities is cost-effective wh en compared to the case-finding and treatment approach. Method A decision-analysis model was designed wherein systematic screening with the tuberculin skin test of all elderly patients newly admitted to fac ilities was compared to public health interventions restricted to investiga tion of cases and contacts with symptoms of tuberculosis after suspected ex posure. Differences in life-years (LY), quality-adjusted life-years (QALY), cost per QALY and LY gained, annual cost per 1000 institutional patients w ere calculated in a health-care system perspective. Results In every situation analysed, screening and chemoprophylaxis were mo re effective. The cost per LY gained was within an acceptable range: $3437 per LY with a 0.6% nosocomial transmission rate and $7552 per LY when no no socomial transmission was postulated. Conclusion Screening plus chemoprophylaxis for high-risk reactors is more c ost-effective than case-finding. This holds even when nosocomial transmissi on is assumed not to occur in facilities.