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Table 3 Base case analysis: Cost-effectiveness of screening 21 year-old travelers for 3-month trips

From: Tuberculosis screening of travelers to higher-incidence countries: A cost-effectiveness analysis

Traveler's destination Traveler group: Annual risk of infection Screening strategy from least to most expensive Expected costs per 1,000 (2005 USD) Expected cases per 1,000 Incremental cost per 1,000 Incremental cases prevented per 1,000 Incremental cost per case prevented
Travelers to Mexico      
US-born: Annual infection risk 0.3%      
   No screening $7,428 1.0 - - -
   Post-trip TST $47,082 0.8 $39,654 0.2 $161,196
   Post-trip chest x-ray $58,972 0.9 $11,890 (0.1) Dominated
   Pre & post trip TST; treatment for reactors $68,644 0.8 $9,672 0.1 Dominated
   Pre & post trip TST; treatment for converters only $68,741 0.9 $97 (0.1) Dominated
Mexican-born: Annual infection risk 0.3%      
   No screening $9,855 1.3 - - -
   Post-trip TST $57,666 1.0 $47,811 0.3 $143,578
   Post-trip chest x-ray $61,087 1.1 $3,421 (0.1) Dominated
   Pre & post trip TST; treatment for converters only $71,335 1.2 $10,248 (0.1) Dominated
   Pre & post trip TST; treatment for reactors $74,372 1.1 $3,037 0.1 Dominated
Travelers to Dominican Republic      
US-born: Annual infection risk 0.8%      
   No screening $13,226 1.7 - - -
   Post-trip TST $51,961 1.3 $38,735 0.4 $102,745
   Post-trip chest x-ray $64,678 1.6 $12,718 (0.3) Dominated
   Pre & post trip TST; treatment for reactors $73,792 1.4 $9,114 0.2 Dominated
   Pre & post trip TST; treatment for converters only $73,889 1.5 $97 (0.1) Dominated
Dominican-born: Annual infection risk 0.8%      
   No screening $25,423 3.3 - - -
   Post-trip TST $73,523 2.6 $48,100 0.7 $65,264
   Post-trip chest x-ray $75,711 2.9 $2,188 (0.3) Dominated
   Pre & post trip TST; treatment for reactors $86,604 2.8 $10,893 0.1 Dominated
   Pre & post trip TST; treatment for converters only $89,568 3.2 $2,964 (0.4) Dominated
Travelers to Haiti      
US-born: Annual infection risk 2.6%      
   No screening $34,041 4.4 - - -
   Post-trip TST $68,756 3.5 $34,715 0.9 $36,931
   Post-trip chest x-ray $85,163 4.3 $16,407 (0.8) Dominated
   Pre & post trip TST; treatment for reactors $91,797 3.8 $6,634 0.5 Dominated
   Pre & post trip TST; treatment for converters only $91,893 3.9 $96 (0.1) Dominated
Haitian-born: Annual infection risk 2.6%      
   No screening $73,594 9.6 - - -
   Post-trip chest x-ray $119,983 8.5 $46,389 1.1 $40,585*
   Post-trip TST $121,073 7.4 $1,090 1.1 $1,014
   Pre & post trip TST; treatment for reactors $133,556 8.1 $12,484 (0.7) Dominated
   Pre & post trip TST; treatment for converters only $135,395 9.2 $1,839 (1.1) Dominated
  1. For each type of traveler, strategies are listed by increasing cost. In the three rightmost columns, the calculation of incremental values (e.g., incremental cost per 1,000) is based on the comparison between each strategy and its next least costly alternative (e.g., a row might show the difference in cost between the second least costly strategy and the least costly strategy; the next row below would then show the cost difference between the third and second least costly strategies; and so on). Values in parentheses indicate an increase in expected cases, instead of cases prevented. "Dominated" means that another strategy is available that is both less costly and effective in preventing more TB cases.
  2. *Dominated by extended dominance. While post-trip chest X-ray is the least costly option, another choice is available which is more attractive on an incremental cost per case prevented basis. The incremental cost per TB case prevented of post-trip TST, compared to no screening, is $21,406.