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Cost-effectiveness analysis of lead poisoning screening strategies following the 1997 guidelines of the Centers for Disease Control and Prevention.

Publication ,  Journal Article
Kemper, AR; Bordley, WC; Downs, SM
Published in: Arch Pediatr Adolesc Med
December 1998

OBJECTIVE: To compare blood lead (BPb) poisoning screening strategies in light of the 1997 recommendations by the Centers for Disease Control and Prevention, Atlanta, Ga. DESIGN: Cost-effectiveness analysis from the perspective of the health care system to compare the following 4 screening strategies: (1) universal screening of venous BPb levels; (2) universal screening of capillary BPb levels; (3) targeted screening of venous BPb levels for those at risk; and (4) targeted screening of capillary BPb levels for those at risk. Costs of follow-up testing and treatment were included in the model. RESULTS: Only universal venous screening detected all BPb levels of at least 0.48 micromol/L (10 microg/dL). Universal capillary screening detected between 93.2% and 95.5% of cases, depending on the prevalence of elevated BPb levels. Targeted screening was the least sensitive strategy for detecting cases. Venous testing identified between 77.3% and 77.9% of cases, and capillary testing detected between 72.7% and 72.8% of cases. In high-prevalence populations, universal venous screening minimized the cost per case ($490). In low- and medium-prevalence populations, targeted screening using venous testing minimized the cost per case ($729 and $556, respectively). In all populations, regardless of screening strategy, venous testing resulted in a lower cost per case than capillary testing. Sensitivity analyses of all parameters in this model demonstrated that this conclusion is robust. CONCLUSIONS: Universal screening detects all cases of lead poisoning and is the most cost-effective strategy in high-prevalence populations. In populations with lower prevalence, the cost per case detected using targeted screening is less than that of universal screening. The benefit of detecting a greater number of cases using universal screening must be weighed against the extra cost of screening. Regardless of whether a strategy of universal or targeted screening is used, the cost per case using venous testing is less than that of capillary testing.

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Published In

Arch Pediatr Adolesc Med

DOI

ISSN

1072-4710

Publication Date

December 1998

Volume

152

Issue

12

Start / End Page

1202 / 1208

Location

United States

Related Subject Headings

  • Veins
  • United States
  • Sensitivity and Specificity
  • Risk
  • Prevalence
  • Practice Guidelines as Topic
  • Population Surveillance
  • Pediatrics
  • Mass Screening
  • Lead Poisoning
 

Citation

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Kemper, A. R., Bordley, W. C., & Downs, S. M. (1998). Cost-effectiveness analysis of lead poisoning screening strategies following the 1997 guidelines of the Centers for Disease Control and Prevention. Arch Pediatr Adolesc Med, 152(12), 1202–1208. https://doi.org/10.1001/archpedi.152.12.1202
Kemper, A. R., W. C. Bordley, and S. M. Downs. “Cost-effectiveness analysis of lead poisoning screening strategies following the 1997 guidelines of the Centers for Disease Control and Prevention.Arch Pediatr Adolesc Med 152, no. 12 (December 1998): 1202–8. https://doi.org/10.1001/archpedi.152.12.1202.
Kemper, A. R., et al. “Cost-effectiveness analysis of lead poisoning screening strategies following the 1997 guidelines of the Centers for Disease Control and Prevention.Arch Pediatr Adolesc Med, vol. 152, no. 12, Dec. 1998, pp. 1202–08. Pubmed, doi:10.1001/archpedi.152.12.1202.

Published In

Arch Pediatr Adolesc Med

DOI

ISSN

1072-4710

Publication Date

December 1998

Volume

152

Issue

12

Start / End Page

1202 / 1208

Location

United States

Related Subject Headings

  • Veins
  • United States
  • Sensitivity and Specificity
  • Risk
  • Prevalence
  • Practice Guidelines as Topic
  • Population Surveillance
  • Pediatrics
  • Mass Screening
  • Lead Poisoning