Cost effectiveness analysis of school based mantoux screening for TB infection

OBJECTIVE: To assess the cost-effectiveness of adding school based Mantoux screening programs to the New South Wales current TB prevention strategy. METHOD: A decision analysis model compared the costs and consequences of sc reening strategies against the current no-screen strategy. Costs associated with screening and with treating future cases of TB were considered. Conse quences considered were deaths and adult cases of TB prevented. The study w as based on data from prevalence surveys conducted in 1992 and 1994 in Cent ral and South Western Sydney, New South Wales. Screening strategies conside red were screening all or only overseas born (OSB) 6 year olds and all or o nly OSB 14 year olds in school settings. RESULTS: Screening 14 year olds prevented more deaths and adult cases of TB than screening 6 year olds for a similar cost. For both age groups targete d screening of OSB children was more cost-effective than screening all chil dren. Targeted screening of 14 year olds - the most cost effective option - cost $17,956 (costs and benefits discounted at 5%) per adult case prevente d, equivalent to approximately $130,000 per life year saved. The cost-effec tiveness ratios decline substantially if lower discount rates and less cons ervative assumptions are applied. CONCLUSION: Targeted screening was more cost effective than screening all c hildren, however, there are ethical implications of targeting a group based on their origin of birth. IMPLICATIONS: As prevention and control of TB continues to be a high priori ty for NSW, the implications of a school based screening program should be seriously considered.