Tuberculosis Prevention in Methadone Maintenance Clinics . Effectiveness and Cost-Effectiveness

• Published in: American journal of respiratory and critical care medicine 1999-07, Vol.160 (1), p.178-185
• Main Authors: SNYDER, DAVID C, PAZ, E. ANTONIO, MOHLE-BOETANI, JANET C, FALLSTAD, ROBERT, BLACK, ROSA LEE, CHIN, DANIEL P
• Format: Article
• Language: English
• Subjects: Adult; AIDS-Related Opportunistic Infections - economics; AIDS-Related Opportunistic Infections - mortality; AIDS-Related Opportunistic Infections - prevention & control; Antitubercular Agents - administration & dosage; Bacterial diseases; Biological and medical sciences; Cost-Benefit Analysis; disease control; Drug Therapy, Combination; Female; Follow-Up Studies; HIV Seropositivity - diagnosis; HIV Seropositivity - economics; HIV Seropositivity - mortality; Human bacterial diseases; Human immunodeficiency virus; Humans; Infectious diseases; Isoniazid - administration & dosage; Male; Mass Screening - economics; Medical sciences; methadone; Methadone - economics; Methadone - therapeutic use; Middle Aged; Mycobacterium tuberculosis; Pyridoxine - administration & dosage; San Francisco; Substance Abuse, Intravenous - economics; Substance Abuse, Intravenous - mortality; Substance Abuse, Intravenous - rehabilitation; Survival Rate; Treatment Outcome; Tuberculin Test - economics; tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Pulmonary - economics; Tuberculosis, Pulmonary - mortality; Tuberculosis, Pulmonary - prevention & control; Urban Population - statistics & numerical data; USA, California, San Francisco
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.160.1.9810082

To determine the effectiveness and cost-effectiveness of a program to provide screening for tuberculosis infection and directly observed preventive therapy (DOPT) in methadone maintenance clinics, we determined completion rates of screening for tuberculosis infection, medical evaluation, and preventive therapy, as well as the number of active tuberculosis cases and tuberculosis-related deaths prevented, in five clinics in San Francisco, California. Between 1990 and 1995, a total of 2,689 clients (of whom 18% were HIV-seropositive) were screened at least once. Of eligible clients, 99% received tuberculin skin tests, 96% received a medical examination, 91% began isoniazid preventive therapy, and 82% completed preventive therapy. Program effectiveness was enhanced by close collaboration between public health and methadone maintenance programs and the use of incentives and enablers. Over a 3-yr follow-up period, only one verified case of tuberculosis was reported among clients with a positive tuberculin skin test, thereby preventing as much as 95% of expected tuberculosis cases. Over 10 yr, we estimate the program would prevent 30.0 (52%) of 57.7 expected cases of tuberculosis, and 7.6 (57%) of 13.4 expected tuberculosis-related deaths. The program cost $771,569, but averted an estimated $876,229, for a net savings of $104,660 (average of $3, 724 per case prevented). Our study demonstrates that when effectively implemented, screening for tuberculosis infection and DOPT in methadone maintenance clinics is a highly cost-effective approach to prevent tuberculosis.