Prevalence and costs of tuberculin screening performed at Altopiano di Asiago (Vicenza) during a decade
NHS Economic Evaluation Database., 1997 See article at www.crd.york.ac.uk
Prevalence and costs of tuberculin screening performed at Altopiano di Asiago (Vicenza) during a decade Full record NHS Economic Evaluation Database (NHS EED) - Full record display Prevalence and costs of tuberculin screening performed at Altopiano di Asiago (Vicenza) during a decade Demi M Source Pediatria Medica e Chirurgica Year published 1997 Volume 19(2) Pages 91-4 Record status This record was compiled by CRD commissioned reviewers according to a set of guidelines developed in collaboration with a group of leading health economists. Health technology Tuberculosis skin test (TST): Tine test. Type of intervention Screening. Hypothesis/study question To assess the cost-effectiveness of TST screening on a pediatric population by means of a Tine-test. The comparator was the 'do nothing' alternative. The Tine-test positive results were confirmed by the means of a 'Mantoux' test. Economic study type Cost-effectiveness analysis. Study population Schoolchildren born between 1976 and 1988 and children between 6 months and 14 years old hospitalised in the local hospital. No further details were given. Setting Hospital. The economic study was carried out in Asiago (VI), Italy. Dates to which data relate The main effectiveness data were derived from a single study conducted between 1986 and 1995. Resource and cost data were taken from 1986-1997 sources. The price year was 1997. Source of effectiveness data The estimates of the screening results for the Tine test and the Mantoux test were derived from a single study. Study designs and other criteria for inclusion in the review Case series study. The duration of the follow-up and the loss to follow-up were not clearly reported. Study sample A total of 5,436 Tine tests over 3,220 schoolchildren were carried out. 1,244 children were tested by the Mantoux test during Hospitalization and 414 children underwent both of the tests by chance. Immunologically depressed children and those who had undergone a Tine test in the previous 6 months were excluded. Information about the number of tests carried out for each age group was provided graphically. Power calculations to determine the sample size were not undertaken. Link between effectiveness and cost data The costing was undertaken retrospectively on the same patient sample as that used in the effectiveness study. Analysis of effectiveness The analysis of the clinical study was based on screening completers only. The primary health outcomes werethe screening results of the Tine test and the Mantoux test. Effectiveness results Thirty-four schoolchildren (1.07%) were Tine test positive, only 3 of whom proved to be positive at the following Mantoux test. Five children out of 1,244 proved to be Mantoux positive during Hospitalization and only 2 cases of tuberculosis were identified. Measure of benefits used in the economic analysis The measure of benefits was the number of positive cases detected. Direct costs The costs of the screening tests, personnel and time spent travelling to the hospital to collect the test resultswere included in the analysis. The quantities were reported separately from the prices. The quantity/cost boundary adopted was the hospital. The price year was 1997. Discounting was not applied. Currency Italian Lire (L). The cost for each Tine positive case confirmed with Mantoux test was also expressed in US dollars ($). The exchange rate used was not reported. Statistical analysis of costs Not undertaken. Sensitivity analysis No sensitivity analysis was performed. Estimated benefits used in the economic analysis Thirty-four schoolchildren (1.07%) were Tine test positive and only 3 out of them proved to be positive at the following Mantoux test. Five children out of 1244 proved to be Mantoux positive during Hospitalization and only 2 cases of tuberculosis were identified. Cost results The personnel cost was L26,455,200. The Tine test cost was L17,938,800. The travelling cost to the hospital was L2,800,000. The total costs were L47,194,000. Synthesis of costs and benefits The cost for each of the positive Tine-test cases confirmed with the Mantoux test was L15,731,000 or about $9,850. Authors' conclusions The results, which suggest that resources should be directed only towards screening children at high risk of tuberculosis infection, are still open to discussion as the cost of each case confirmed in such a wide population was high. Clinical conclusions The Tine test showed a high sensitivity. CRD commentary Selection of comparators: The reason for the choice of the comparator is clear. There was little information about tuberculosis diffusion in Italy. The area selected had been characterised by a tuberculosis prevalence rate greater than 5% during the 1970s. You, as a user of this database, should consider whether screening using these health technologies is relevant to your own setting. Validity of estimate of measure of benefit: The estimate of cases detected is likely to be internally valid. The data have not been used selectively to prove theeffectiveness of the proposed tests. Validity of estimate of costs: Resources were reported separately from the prices. Adequate details of methods of quantity/cost estimation were given. Important cost items do not appear to have been omitted. Other issues: The authors' conclusions are likely to be justified given the uncertainties in the data. The issue of generalisability to other settings was not addressed. Appropriate comparisons were not made with other studies. The results do not appear to have been presented selectively. Country code Italy Subject index terms status Subject indexingassigned by NLM Subject index terms Adolescent; Child; Child,-Preschool; Costs-and-Cost-Analysis; English-Abstract; Infant;Infant,-Newborn; Italy/ep [epidemiology]; Mass-Screening/ec [economics];Prevalence; Tuberculin-Test/ec [economics]; Tuberculosis/ep [epidemiology];Tuberculin-Test; Tuberculosis/pc [prevention-&-control]; Comparative-Study;English-Abstract; Humans Funding body None stated. Accession number 21997007069 Database entry date 31 March 1999 Language published in Italian English summary Yes Address for correspondence Dr M Demi, Divisione di Pediatria, Ospedale Civile, ULSS n.3 della Regione Veneto, 36012 Asiago (VI), Italy NHS Economic Evaluation Database (NHS EED) Produced by the Centre for Reviews and Dissemination Copyright © 2006 University of York
