Community-based tuberculin screening in Montreal: a cost-outcome description

Am J Public Health. 1995 Jun;85(6):786-90. doi: 10.2105/ajph.85.6.786.


Objectives: This study describes the costs and outcomes of community-based tuberculin screening programs conducted between 1987 and 1991 in Montreal, Quebec, Canada.

Methods: Follow-up information was abstracted from hospital records of all reactors detected in tuberculin screening of students in grades 6 and 10, of first-year health professional students, and of workers aged 18 to 25 in a number of workforces. Screening costs were estimated directly from survey records, and follow-up costs were estimated from the annual financial report of the Montreal Chest Hospital for 1989/90.

Results: Of 7669 persons tested, 782 (10.2%) had positive results and 757 (9.9%) were referred to a clinic. Of those, 525 (6.8% of the original 7669) reported, 293 (3.8%) were prescribed therapy, and 154 (2.0%) were compliant. In Canadian dollars, screening cost $5.70 per person tested and $56 per tuberculin reactor detected, but follow-up of reactors accounted for 73% of the total program cost of $13,455 to $18,753 per case of tuberculosis prevented.

Conclusions: Because of high rates of patient and provider noncompliance, a tuberculin screening program was much less cost-effective than anticipated. Screening costs must be targeted to the highest risk populations, and compliance with recommendations for preventive therapy must be maximized.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Humans
  • Mass Screening* / economics*
  • Patient Compliance
  • Quebec
  • Tuberculin Test / economics*
  • Tuberculosis / economics
  • Tuberculosis / prevention & control
  • Tuberculosis / therapy