Prevalenza e costi di uno screening tubercolinico decennale eseguito sull'Altopiano di Asiago (Vicenza) [Prevalence and costs of tuberculin screening performed at Altopiano di Asiago (Vicenza) during a decade]
Demi M
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Tuberculosis skin test (TST): Tine test.
Type of intervention
Screening.
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.
Link between effectiveness and cost data
The costing was undertaken retrospectively on the same patient sample as that used in the effectiveness study.
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.
Study design
Case series study. The duration of the follow-up and the loss to follow-up were not clearly reported.
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.
Clinical conclusions
The Tine test showed a high sensitivity.
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.
Statistical analysis of costs
Not undertaken.
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.
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.
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.
Source of funding
None stated.
Bibliographic details
Demi M. Prevalenza e costi di uno screening tubercolinico decennale eseguito sull'Altopiano di Asiago (Vicenza). [Prevalence and costs of tuberculin screening performed at Altopiano di Asiago (Vicenza) during a decade] Pediatria Medica e Chirurgica 1997; 19(2): 91-94