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Article
November 1996

A Comparison of Screening Strategies for Elevated Blood Lead Levels

Author Affiliations

From the Departments of Pediatrics (Drs Campbell and Schaffer) and Community and Preventive Medicine (Ms Paris), University of Rochester School of Medicine and Dentistry, Rochester, NY.

Arch Pediatr Adolesc Med. 1996;150(11):1205-1208. doi:10.1001/archpedi.1996.02170360095016
Abstract

Objective:  To calculate and compare the average expected cost per child screened (hereafter referred to as COST) among various screening strategies.

Design:  A decision analysis of 5 strategies: (1) conduct risk assessment and screen high-risk children by venipuncture, low-risk children by fingerstick; (2) screen all children by fingerstick; (3) screen all children by venipuncture; (4) conduct risk assessment, screen high-risk children by fingerstick; and (5) conduct risk assessment, screen high-risk children by venipuncture. We assumed all fingerstick blood lead levels of 0.72 μmol/L or higher (≥15 μg/dL) would be confirmed by venipuncture. Baseline variables taken from the literature included prevalence of elevated blood lead levels in the pediatric population (2%), sensitivity and specificity of fingerstick blood lead assay (90% each), specificity of risk assessment (50%), sensitivity of risk assessment at blood lead levels of 0.48 to 0.68 μmol/L (10-14 μg/dL and 0.72 μmol/L or higher (≥15 μg/dL) (65% and 85%, respectively), cost of blood lead assay ($6), cost to obtain blood by venipuncture ($4) and fingerstick ($2), and cost to get a child who has a fingerstick blood lead level of 0.72 μmol/L or higher (≥15 μg/dL) to return ($0.18). Sensitivity analysis determined whether selected variables affected the COST.

Results:  The COSTs for strategies 1 through 5 were $9.07, $8.16, $10, $4.13, and $5.04, respectively. Among the universal strategies, screening children by fingerstick had the lowest COST at a prevalence of less than 38% and fingerstick blood lead assay a specificity of greater than 62%. Among the selective strategies, screening high-risk children by fingerstick had the lowest COST at a prevalence of less than 38% and fingerstick blood lead an assay specificity of greater than 63%.

Conclusion:  At a readily attainable specificity of the fingerstick blood lead assay, practices serving a patient population with a prevalence of elevated blood lead levels of less than 38% will have the lowest COST when a fingerstick screening strategy is used.Arch Pediatr Adolesc Med. 1996;150:1205-1208

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