Table 2

Costs of screening for tuberculosis

Costs (savings) (£)
Cost centreHospitalHomelessGeneral 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 total1). ¶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 infectious18) and that 10% of those infected have a life time risk of developing active tuberculosis.8,9
Nursing*7440504216
Medical equipment and materials†476287207
Clerical‡518518Not applicable
Subtotal: screening process13101809423
Treatment§94772541462
BCG vaccination¶6810253
Subtotal: treatment costs95452643515
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)0.57
Cost per person screened per case prevented10226.32