Cost-effectiveness of the two-step skin test for tuberculosis screening of employees in a community hospital.

To assess the frequency of the booster effect as well as the need for and the cost effectiveness of the two-step skin test for tuberculosis screening at our medical center, we conducted a pilot study from June 1980 to March 1983 with hospital and clinic employees. Six (0.4%) of 1,521 employees tested by the two-step skin test demonstrated the booster effect. The mean age of these six employees was 35 years (range, 24 to 44 yr). During the study period, 10 employees converted to a positive skin test. The booster effect would have accounted for approximately 38% (6 of 16) of those converting if the two-step testing were not performed. At our medical center, the additional cost of the two-step skin test was low and justifiable for medical and epidemiologic reasons. We suggest that each hospital review the prevalence of tuberculosis among its patient and employee populations. The need for and cost effectiveness of the two-step skin test for new hospital employees must be re-examined on the basis of these data.