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

BACKGROUND: While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis. OBJECTIVES: We evaluated the costs and benefits of expanding pre-departure tuberculosis screening requirements to a subset of NIVs who arrive from a moderate (Mexico) or high (India) incidence tuberculosis country with temporary work visas. METHODS: We developed a decision tree model to evaluate the program costs and estimate the numbers of active tuberculosis cases that may be diagnosed in the United States in two scenarios: 1) "Screening": screening and treatment for tuberculosis among NIVs in their home country with recommended U.S. follow-up for NIVs at elevated risk of active tuberculosis; and, 2) "No Screening" in their home country so that cases would be diagnosed passively and treatment occurs after entry into the United States. Costs were assessed from multiple perspectives, including multinational and U.S.-only perspectives. RESULTS: Under "Screening" versus "No Screening", an estimated 179 active tuberculosis cases and 119 hospitalizations would be averted in the United States annually via predeparture treatment. From the U.S.-only perspective, this program would result in annual net cost savings of about $3.75 million. However, rom the multinational perspective, the screening program would cost $151,388 per U.S. case averted for Indian NIVs and $221,088 per U.S. case averted for Mexican NIVs. CONCLUSION: From the U.S.-only perspective, the screening program would result in substantial cost savings in the form of reduced treatment and hospitalization costs. NIVs would incur increased pre-departure screening and treatment costs.

To your health!: Re-examining the health benefits of moderate alcohol use.

Although excessive alcohol use and alcohol misuse contribute to a broad range of health problems, recent research indicates that moderate alcohol consumption may in fact be beneficial. The present study builds on previous research to investigate the associations between alcohol use and self-rated health status among young adults. Using data collected in 2008 from the National Longitudinal Survey of Adolescent to Adult Health (Add Health), we use ordered probit models to determine whether the protective effects of moderate alcohol use are present after controlling for demographic, lifestyle, family background, and health-related characteristics. Our findings generally support earlier research with older samples, but some key gender differences are present. For women (n = 8275), moderate drinkers have better self-rated health status relative to former drinkers, infrequent drinkers, and light drinkers. Among men (n = 7207), the effects are mixed and less often significant. Differences in results between men and women point to the need for further gender-specific research and studies with other measures of health.