The cost-effectiveness of preventing tuberculosis in physicians using tuberculin skin testing or a hypothetical vaccine.
Tuberculin skin testing using the purified protein derivative is recommended as part of a tuberculosis control program for health care workers.
However, compliance with skin testing programs has been poor and their cost-effectiveness is unknown.
A Markov-based decision analysis was performed to determine the cost-effectiveness of tuberculin skin testing over the entire lifetimes of physicians who are now in medical school.
Assumptions were deliberately chosen to present a conservative estimate of cost-effectiveness.
Indirect costs were not included.
Annual testing cost $29 000 per life-year saved and $39 000 per case of pulmonary tuberculosis prevented.
In contrast, particulate respirators have been shown to cost millions of dollars per case prevented.
Skin testing every 6 months was cost-effective in a subpopulation at high risk of infection (=1.8-fold).
During their entire lifetimes, physicians now in medical school can expect to avert 137 cases of pulmonary tuberculosis, prevent 7 tuberculosis deaths, and save 182 life-years because of skin testing programs.
Improved compliance with annual skin testing and prophylactic isoniazid could more than triple this benefit.
If available, a moderately effective vaccine would be even more cost-effective than tuberculin skin testing programs.
Tuberculin skin testing is cost-effective and should be an integral part of any tuberculosis control program. (...)
Mots-clés Pascal : Vaccination, Prévention, Tuberculose, Mycobactériose, Bactériose, Infection, Tuberculine, Test cutané, Rapport coût bénéfice, Evaluation, Relation médecin malade, Homme, Education santé, Immunoprophylaxie
Mots-clés Pascal anglais : Vaccination, Prevention, Tuberculosis, Mycobacterial infection, Bacteriosis, Infection, Tuberculin, Skin test, Cost benefit ratio, Evaluation, Physician patient relation, Human, Health education, Immunoprophylaxis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0321523
Code Inist : 002B05A02. Création : 12/09/1997.