Costs (savings) (£) | |||
---|---|---|---|
Cost centre | Hospital | Homeless | General practice |
*Calculated as time and % salary. General practice required 45 seconds for a verbal screening, 2.5 minutes for a Heaf test, and 2.5 minutes for the follow up reading; homeless screening required two half-days at each site for three nurses grades E, F and G; new entrant screening accounts for 40% of the tuberculosis nurse specialist at the Homerton Hospital. †Disposable Heaf gun heads £1 each; tuberculin costs £5.89 per 1 ml ampoule; Heaf guns cost £20 and can be used for 1000 tests. ‡Calculated as time and % of salary, including stationery. The additional cost to a registration health check was deemed negligible. | |||
§Chemoprophylaxis costs £220 for a series of outpatient visits and £11 for drugs; the cost for a case of tuberculosis is estimated at £2697, constituting £201 for investigations, an inpatient stay of 7.28 days at £198 per day, eight outpatient visits at £63 per visit, drug costs of £191, and contact tracing of £360 per smear positive case (35% of total^{1}). ¶BCG vaccination assumes a total of 12 minutes for consent, vaccination, and follow up and £1 per vaccine dose. **Assumes that each case of tuberculosis gives rise to three others (or, more strictly, that infectious tuberculosis gives rise to nine other cases, three of which are infectious^{18}) and that 10% of those infected have a life time risk of developing active tuberculosis.^{8,}^{9} | |||
Nursing* | 7440 | 504 | 216 |
Medical equipment and materials† | 476 | 287 | 207 |
Clerical‡ | 5185 | 18 | Not applicable |
Subtotal: screening process | 13101 | 809 | 423 |
Treatment§ | 9477 | 2541 | 462 |
BCG vaccination¶ | 68 | 102 | 53 |
Subtotal: treatment costs | 9545 | 2643 | 515 |
Total costs | 22646 | 3452 | 938 |
Savings [no of cases prevented]** | (25 621) [9.5] | (1618) [0.6] | (594) [0.2] |
Total | (2976) | 1834 | 344 |
Cost per person screened | (12.7) | 0.5 | 7 |
Cost per person screened per case prevented | 10 | 22 | 6.32 |