A cost-effectiveness analysis is used to compare two alternative strategies for the control of tuberculosis in facilities providing long-term care to the elderly: (1) systematic screening of all new residents with the Mantoux test to identify persons infected with the tubercule bacillus, and preventive treatment of those who are most at risk of tuberculosis as recommended by the U.S. Department of Health and Human Services and (2) clinical follow-up of the index-case contacts as recommended by the Quebec Ministry of Health and Social Services. Incremental effectiveness and cost associated with the American strategy are estimated with a Markov model applied to the Quebec long-term care facilities population. Costs are estimated in the perspective of the health care system. Even though complications due to isoniazid chemoprophylaxis cluster in the year following admission, the American approach is advantageous. At the end of the implementation phase throughout the province of Quebec, this approach prevents 32 cases of tuberculosis annually. The incremental cost is 121 626$ per year for the entire province, 3 822 $ per case avoided, 9 555$ per death avoided, 3 437 $ per life-year saved and 2 756$ per quality-adjusted life-years saved. Those costs compare favourably to other health prevention measures recommended for the elderly population.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.68213 |
| Date | January 1993 |
| Creators | Marchand, Robert |
| Contributors | Tousignant, Pierre (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | French |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Master of Science (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001397068, proquestno: AAIMM94471, Theses scanned by UMI/ProQuest. |
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