Mohle-Boetani J C, Miller B, Halpern M, Trivedi A, Lessler J, Solomon S L, Fenstersheib M
Disease Control and Prevention Division, County of Santa Clara Public Health Department, San Jose, CA, USA.
JAMA. 1995;274(8):613-9.
To compare tuberculin screening of all kindergartners and high school entrants (screen-all strategy) vs screening limited to high-risk children (targeted screening).
Decision, cost-effectiveness, and cost-benefit analyses.
Students in a large urban and rural county.
High risk of tuberculosis infection was defined as birth in a county with a high prevalence of tuberculosis. Low risk was defined as birth in the United States.
Tuberculosis cases prevented for 10, 000 children screened. Net costs, net cost per case prevented, benefit-cost ratio, and incremental cost-effectiveness.
The screen-all strategy would prevent 14.9 cases per 10,000 children screened; targeted screening would prevent 84.9 cases per 10,000 children screened. The screen-all strategy is more costly than no screening; the benefit-cost ratio is 0.58. Targeted screening would result in a net savings; the benefit-cost ratio is 1.2. Screening all children is cost saving only if the reactor rate is 20% or greater. The cost per additional case prevented for screening all children compared with targeted screening (+34 666) is more than twice as high as treatment and contact tracing for a case of tuberculosis (+16 392).
Targeted screening of schoolchildren is much less costly than mass screening and is more efficient in prevention of tuberculosis.
比较对所有幼儿园儿童和高中入学新生进行结核菌素筛查（全面筛查策略）与仅对高危儿童进行筛查（目标性筛查）的效果。
决策分析、成本效益分析和成本效益分析。
一个大型城乡县的学生。
结核病感染高危定义为出生在结核病高流行县。低危定义为出生在美国。
每筛查10000名儿童预防的结核病病例数。净成本、每预防一例的净成本、效益成本比和增量成本效益。
全面筛查策略每筛查10000名儿童可预防14.9例；目标性筛查每筛查10000名儿童可预防84.9例。全面筛查策略比不筛查成本更高；效益成本比为0.58。目标性筛查可实现净节省；效益成本比为1.2。仅当反应率为20%或更高时，对所有儿童进行筛查才具有成本效益。与目标性筛查相比，对所有儿童进行筛查每多预防一例的成本（+34666）是一例结核病治疗和接触者追踪成本（+16392）的两倍多。
对学童进行目标性筛查的成本远低于大规模筛查，且在预防结核病方面更有效。
