Pre-Kindergarten TB Testing Not Cost-Effective, UCSF Study Finds

The healthcare system in California could save nearly $1.3 million a year with few adverse public health effects if it discontinued universal tuberculosis skin testing of children entering kindergarten, according to a new study by researchers at the University of California, San Francisco (UCSF).

Over a 20-year period, the study projects that only two additional cases of tuberculosis would result from screening the pre-kindergarten group.

Valerie Flaherman, MD, MPH, research fellow in the UCSF Department of Pediatrics, is principal author of the report, which appears in the July issue of Pediatrics, the journal of the American Academy of Pediatrics.

Pre-kindergarten screening is not a cost-effective way to spend our healthcare dollars, Flaherman said. You need about 7 percent of the children who are being screened to test positive in order for pre-kindergarten screening to be cost-effective. That may have been the case in the past, but now often less than 1 percent test positive.

Tuberculosis remains a persistent health threat in California, with more than 2,800 cases reported in the state in 2006. California has more cases of tuberculosis in young children than any other state. The savings from eliminating universal tuberculosis skin testing of youngsters could be redirected toward more cost-effective methods of stopping the spread of the disease, according to Flaherman. Instead, finding and treating adults with tuberculosis would be a better approach to stopping the spread of the disease to children, she said.

The tuberculosis skin test, also known as the tuberculin or PPD test, is used to determine whether someone has been infected by breathing in the germs from a person with active TB. People with latent TB infection have no symptoms and usually have a positive tuberculin skin test. They cannot spread TB to others, but need treatment to prevent them from developing active TB in the future.

By contrast, people with active TB are usually sick with symptoms that can include a cough of more than three weeks duration, coughing up blood, fever, chills, night sweats, weight loss and fatigue. They need treatment that stops them from spreading TB to others.

The study, titled "Cost-effectiveness of Alternative Strategies for Tuberculosis Screening before Kindergarten," was conducted using a computer-based decision analysis model that calculated costs and benefits of routine, or universal, TB screening, targeted screening according to risk factors, and no screening at all. Flahermans research team found that the use of targeted testing instead of routine testing would save California $1.27 million savings per year.

This study provides tools that health officials can use to tailor TB screening decisions to the particular circumstances of their communities, said Flaherman.

Other co-authors of the research are Travis Porco and Elliott Marseille of Health Strategies International and UCSF, and Sarah Royce, California Department of Health Services, Tuberculosis Control Branch.

Source: UCSF