Economic evaluation of targeted tuberculosis testing of children entering school in Los Angeles County

OBJECTIVES: To estimate the health and economic consequences of changing Los Angeles County's current policy of universal tuberculosis (TB) testing of children entering school to one of screening and targeted testing . METHODS: We built a Markov decision model of the transition between four health states (non-infected, latent TB infection, active TB infection, and death) for a cohort of 120,000 children from the time of school entry and until age 18. Using model results, we compared health and economic outcomes under the current and proposed policies from the societal and government perspectives. Model parameters and ranges for sensitivity analysis were estimated from data collected by the Tuberculosis Control Program, taken from the literature, and derived from expert consensus. RESULTS: We estimated the reduction in total costs to society and Los Angeles County from switching from universal to targeted TB testing, as well as the associated decrease in diagnosed cases of latent TB. We also estimated the incremental cost of preventing a case of active TB with universal testing. Sensitivity analysis was used to identify the model inputs that are the main drivers of our results. CONCLUSIONS: Switching from universal to targeted TB testing of children entering school in Los Angeles County will result in significant cost savings to the Los Angeles County Department of Public Health with minimal negative impacts on health.