MISSED OPPORTUNITIES FOR TUBERCULOSIS PRE VENTION AND DERIVATED COSTS

BACKGROUND: We determined the extent to which opportunities for preven tion were missed among patients with tuberculosis and the costs derive d from the lack of prevention. METHODS: Descriptive study of patients with active tuberculosis were studied in the hospital ward of tubercul osis at the A. Marcide-Novoa Santos Centre (Ferrol, Spain), from Septe mber of 1991 to August of 1995. Risk factors to develop tuberculosis, vaccination with BCG, previous tuberculin skin test and previous histo ry of drug prophylaxis or tuberculosis therapy were determinated. Then , we determined whether they had undergone prevention procedures in ac cordance with current recommendations of the American Thoracic Society . An evaluation of the direct and indirect derivated costs was carried out in patients with any missed opportunity for tuberculosis preventi on. RESULTS: Out Of 433 studied patients, 167 (38.6%) got missed any o pportunity for prevention. Out of 167, 29 patients (6.7%) did not comp lete a previous treatment; 9 (2.1%) did not complete drug prophylaxis; 12 (2.8%) with known previous positive tuberculin skin test and an in dication for drug prophylaxis never received it, and 117 (27%) with kn own indications for screening never received a skin test. 62 patients (53%) with known exposure to active pulmonary tuberculosis, and 65 (55 .6%) with predisposing medical conditions. From the missed opportuniti es for prevention we calculated some direct costs of 116,909,911 peset as and some indirect costs derivated from the absence to work (141.9 /- 114.3 days) and from the death of 6 patients for tuberculosis, CONC LUSIONS: A large percentage of missed opportunities to prevent the dis ease was found among patients with tuberculosis. This means a consider able expense that could have been avoided.