Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas

Table 2 Costs of tuberculosis medical exam and treatment for visa applicants, by country

Medical components	United States	Cost in USD (2013)	Medical components	India	Mexico
Medical components	diagnostic & follow-up visits (quantity)^a	Cost in USD (2013)	Medical components	Cost in USD (2013)^b	Cost in USD (2013)^b
Chest radiograph	3	$35.82	Panel physician screening exam	$26.46	$190
Sputum smears	5	$9.99	Chest radiograph	Included in exam fee, $6.00 for subsequent	Included in exam fee
Cultures	5	$20.07	Sputum smears	$32.68	Included in exam fee
Complete blood count with differential	3	$7.93	Cultures	$32.68	Included in exam fee
Serum chemistry	1	$15.71	Treatment at panel physician site	$79.40	Included in exam fee
Drug susceptibility tests	4	$10.50	Additional medical exams^c	$259.00	Included in exam fee
Hepatic function panel	3	$15.17	Treatment at local healthcare site	60.00	Included in exam fee

Notes: In the United States, each person with active tuberculosis receives three diagnostic visits and five follow-up visits. The costs for medical components were computed using the 2013 Physician Fee Schedule from the Centers for Medicare and Medicaid Services
Diff differential
^aPersons with Class B1 TB designation do not receive all diagnostic and follow-up visits unless they are diagnosed with active tuberculosis
^bAll prices obtained from Indian and Mexican panel physicians and are presented in 2013 dollars. We estimated that 30% of the panel physician screening exam costs in India is attributable to TB, and 50% of the panel physician screening exam in Mexico costs is attributable to TB. Note that the higher fraction is assumed for Mexico, because, in India, culture/smear testing and treatment are charged separately only for applicants that need such services. Treatment at panel physician consists of the medication and directly observed therapy
^cAdditional medical exams means the total costs for additional smears, cultures, chest radiographs, drug susceptibility testing, and liver testing at panel physician sites

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