Cost of Annual Tuberculosis Screening of Healthcare Workers with Negative Tuberculin Skin Test Results

2013 ◽  
Vol 34 (6) ◽  
pp. 642-643
Author(s):  
J. Brooks Jackson ◽  
Xuguang Tao ◽  
Laurie Sneed ◽  
Frances Humphrey-Carothers ◽  
Edward Bernacki
Keyword(s):  
Medical School ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Screening Program ◽  
Healthcare Providers ◽  
Johns Hopkins Hospital ◽  
Tuberculosis Screening ◽  
Screening Programs ◽  
Screening Cost ◽  
The Cost

The Centers for Disease Control and Prevention (CDC) recommends annual screening for Mycobacterium tuberculosis infection using the tuberculin skin test (TST) for individuals working in hospitals with 200 or more inpatient beds that have at least 6 documented cases of active tuberculosis (TB) per year. The cost of annual TB screening programs is significant, but the cost per individual with TST conversion is unknown. Therefore, we evaluated the annual TB screening program at the Johns Hopkins Hospital and Medical School to determine (1) the proportion of individuals with TST conversion among individuals in the annual TB screening program with patient care exposure at the Johns Hopkins Hospital and Medical School, (2) which employment and demographic factors are associated with TST conversion, (3) the prevalence of active TB disease among those with TST conversion, and (4) the annual cost of subsequent screening of individuals with initial negative TST results and the screening cost per individual with TST conversion.TST results were reviewed for individuals participating in the annual TB screening program during the previous 4 years (2007–2010) at the Johns Hopkins Hospital and Medical School, which has experienced an average of 12 documented cases of active TB per year. TST was performed before employment and then annually for healthcare providers according to CDC guidelines and the manufacturer's directions. Individuals in the testing program included anyone who had patient contact, such as physicians, nurses, technologists, students, phlebotomists, nutritionists, pharmacists, and clerks. All initial testing was 2-step testing if the individual was initially reactive.

scholarly journals Implementing a Large-Scale Systematic Tuberculosis Screening Program in Correctional Facilities in South Africa

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Vincent Zishiri ◽  
Salome Charalambous ◽  
Maunank R. Shah ◽  
Violet Chihota ◽  
Liesl Page-Shipp ◽  
...  
Keyword(s):  
South African ◽  
Large Scale ◽  
Screening Program ◽  
High Volume ◽  
Treatment Costs ◽  
Correctional Facilities ◽  
Tuberculosis Screening ◽  
Pulmonary Tb ◽  
Screening Programs ◽  
The Cost

Abstract Background.  Tuberculosis (TB) prevalence is high in correctional facilities in southern Africa. With support from local South African nongovernmental organizations, the South African Department of Correctional Services initiated a program of systematically screening newly admitted and current inmates for symptoms followed by GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (Rif) for microbiologic testing of symptomatic inmates. Methods.  We conducted a program evaluation during a 5-month window describing program reach, effectiveness, adoption within the facilities, cost, and opportunities for sustainability. This evaluation included 4 facilities (2 large and 2 smaller) with a total daily census of 20 700 inmates. Results.  During the 5-month evaluation window from May to September 2013, 7426 inmates were screened at the 4 facilities. This represents screening 87% of all new admits (the remaining new admits were screened by correctional staff only and are not included in these statistics) and 23% of the daily inmate census, reaching 55% of the overall screening target as calculated per annum. The reach ranged from 57% screened during these 5 months at one of the smaller facilities to 13% at the largest facility. Two hundred one cases of pulmonary TB were diagnosed, representing 2.1% of the screened population; 93% had documented initiation of TB treatment. The cost per TB case identified was $1513, excluding treatment costs (with treatment costs it was $1880). Conclusions.  We reached a large number of inmates with high-volume screening and effectively used GeneXpert MTB/Rif to diagnose pulmonary TB and rapidly initiate treatment. The cost was comparable to other screening programs.

High Rate of Negative Results of Tuberculin and QuantiFERON Tests Among Individuals With a History of Positive Skin Test Results

2006 ◽  
Vol 27 (5) ◽  
pp. 436-441 ◽  
Author(s):  
Lloyd N. Friedman ◽  
Esther R. Nash ◽  
June Bryant ◽  
Susan Henry ◽  
Julia Shi ◽  
...  
Keyword(s):  
Skin Test ◽  
Significant Proportion ◽  
High Rate ◽  
Negative Group ◽  
Tuberculosis Screening ◽  
Positive Skin ◽  
Screening Programs ◽  
History Of ◽  
Positive Results

Objectives.To evaluate individuals at high risk for tuberculosis exposure who had a history of a positive tuberculin skin test (TST) result in order to determine the prevalence of unsuspected negative TST results. To confirm these findings with the QuantiFERON-TB test (QFT), an in vitro whole-blood assay that measures tuberculin-induced secretion of interferon-γ.Methods.This survey was conducted from November 2001 through December 2003 at 3 sites where TST screening is regularly done. Detailed histories and reviews of medical records were performed. TSTs were placed and read by 2 experienced healthcare workers, and blood was drawn for QFT. Any subject with a negative result of an initial TST during the study (induration diameter, <10 mm) underwent a second TST and a second QFT. The TST-negative group comprised individuals for whom both TSTs had an induration diameter of <10 mm. The confirmed-negative group comprised individuals for whom both TSTs yielded no detectable induration and results of both QFTs were negative.Results.A total of 67 immunocompetent subjects with positive results of a previous TST were enrolled in the study. Of 56 subjects who completed the TST protocol, 25 (44.6%; 95% confidence interval [CI], 31.6%-57.6%) were TST negative (P<.001). Of 31 subjects who completed the TST protocol and the QFT protocol, 8 (25.8%; 95% CI, 10.4%-41.2%) were confirmed negative (P<.005).Conclusions.A significant proportion of subjects with positive results of a previous TST were TST negative in this study, and a subset of these were confirmed negative. These individuals' TST status may have reverted or may never have been positive. It will be important in future studies to determine whether such individuals lack immunity to tuberculosis and whether they should be considered for reentry into tuberculosis screening programs.

scholarly journals Is the QuantiFERON-TB Blood Assay a Good Replacement for the Tuberculin Skin Test in Tuberculosis Screening?

2009 ◽  
Vol 132 (5) ◽  
pp. 678-686 ◽  
Author(s):  
Xiangrong Zhao ◽  
Damir Mazlagic ◽  
Ethan A. Flynn ◽  
Helda Hernandez ◽  
Charles L. Abbott
Keyword(s):  
Tuberculin Skin Test ◽  
Skin Test ◽  
Tuberculosis Screening ◽  
Blood Assay

Simulated Lifetime Costs of Three Types of Employer-Based, Periodic, Breast Cancer Screening Programs for Working-Age Women

1994 ◽  
Vol 9 (2) ◽  
pp. 137-146 ◽  
Author(s):  
Robert I. Griffiths ◽  
Claudia B. Griffiths ◽  
Neil R. Powe
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Screening Program ◽  
Lifetime Cost ◽  
Decision Analysis Model ◽  
Screening Programs ◽  
Mean Lifetime ◽  
Lifetime Costs ◽  
The Cost

Purpose. To estimate the lifetime cost of three types of employer-sponsored breast cancer screening programs and to identify factors influencing cost. Design. A computerized decision analysis model was constructed to compare lifetime costs of providing breast cancer screening in each of three screening programs: on-site within an employer, mobile unit visiting the employer, and off-site. Subjects. Three hypothetical cohorts of 10,000 female employees 38 years of age at time of first screening. Intervention. A cohort was enrolled in each screening program and received screening from age 38 through age 64. Employees continued to receive benefits related to breast cancer until age 100 or death. Measures. Costs in the model included those for screening, workup for a suspicious mammogram, treatment for breast cancer, short-term losses in employee productivity, and disability due to breast cancer. Approach. The model was used to estimate the mean lifetime cost per employee, to the employer, of the On-Site program. This cost was compared to the cost of the other programs. Results. Mean lifetime cost per employee was $5,485 for the On-Site screening program. This cost was significantly (P<.0001) lower than in the Off-Site program (by $311) or the Mobile program (by $212). The baseline results for the On-Site program were quite sensitive to the cost of screening, the sensitivity and specificity of screening, age at initiation of screening, and the underlying incidence of breast cancer in the population. Conclusion. Employers and other entities should consider these factors such as location and content in selecting the most efficient and effective breast cancer screening program.

scholarly journals How to Choose Diseases for Newborn Screening by Tandem Mass Spectrometry Under the Nationally Recommended Program in Shenzhen, China Evidence From a Cost-Effectiveness Analysis

2021 ◽  
Author(s):  
Mingren Yu ◽  
Juan Xu ◽  
Xiaohong Song ◽  
Jiayue Du
Keyword(s):  
Mass Spectrometry ◽  
Cost Effectiveness ◽  
Tandem Mass Spectrometry ◽  
Newborn Screening ◽  
Screening Program ◽  
Cost Effective ◽  
Tandem Mass ◽  
National Program ◽  
Screening Programs ◽  
The Cost

Abstract Background: Newborn screening (NBS) can prevent inborn errors of metabolism (IEMs), which may cause long-term disability and even death in newborns. However, in China, tandem mass spectrometry (MS/MS) screening has just started. This study is to determine the cost-effectiveness of NBS using MS/MS in Shenzhen under the nationally recommended program, and determine IEMs for detection.Methods: A Markov model was built to estimate the cost and quality-adjusted life-years (QALYs) of different screening programs. The current screening program and nationally recommended program were compared and we also compared the programs detecting different numbers of IEMs, which are chosen from the national program. A sensitivity analysis and budget impact analysis (BIA) were performed.Results: The incremental cost-effectiveness ratio (ICER) of detecting all 12 IEMs in the national program is 277,823 RMB per QALY, below three times per capita GDP in Shenzhen. MS/MS screening in Shenzhen can be cost-effective only if at least three diseases (PKU, PCD and MMA) are covered and when the screening program covers five diseases (PKU, PCD, MMA, MSUD, IVA), the ICER closely approaches its critical value. The BIA indicated the implementation cost of the national program to be around 580 million RMB over 10 years and showed no difference in budget between programs detecting different numbers of IEMs. Conclusions: We conclude that the newborn screening using MS/MS in Shenzhen is cost-effective, and the budget affordable for the Shenzhen government. Two concepts for selecting the IEMs to be detected, which we label the “ICER maximization idea” and the “ICER validation idea” are also presented.

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