Costs and Benefits of a Universal Screening Program for Elevated Blood Lead Levels in 1-year-old-children

Background. In 1991, the Centers for Disease Control recommended screening all children for elevated blood lead levels, that is blood lead levels of at least 10 micrograms per deciliter, except in communities where large numbers or percentages of children have been screened and found not to have lead poisoning. We have quantitatively compared the economic costs and benefits of universal screening to help refine guidance on screening and to define information gaps in evaluating the effectiveness, costeffectiveness, and economic benefits of blood lead screening. Methods. We used mathematical simulations of a blood lead level screening program to estimate the costs and benefits of universal screening as the prevalence of elevated blood lead levels varied. To do this, we estimated 1) the distribution of elevated blood lead levels in 1-year-old children, 2) the accuracy of blood lead screening tests, 3) the costs of screening for and intervening to reduce elevated blood lead levels, 4) the effectiveness of interventions to reduce blood lead levels, 5) the relationship of elevated blood lead levels to adverse health outcomes, and 6) the economic costs of lead-related adverse health effects. Results. As the observed prevalence of elevated blood lead levels increased, the cost, effectiveness, and economic benefits of universal screening increased. When more than 14% of children had elevated blood lead levels, the economic benefits of universal screening exceeded the costs. When less than 14% of children had elevated blood lead levels, the costs of universal screening exceeded the benefits. The simulations were reasonably robust to changes in most assumptions; changing most assumptions within broad ranges resulted in relatively modest changes in the threshold prevalence at which benefits of screening exceeded the costs within a range of 11% to 17%. This threshold prevalence was, however, very sensitive to the estimated effectiveness of educating families of children with elevated blood lead levels about ways to reduce lead exposures and, to a lesser extent, to the estimated costs and effectiveness of environmental interventions for reducing children’s blood lead levels. Discussion. In mathematical simulations of a blood lead screening program, universal screening for elevated blood lead levels produced economic benefits exceeding program costs in communities where at least 11% to 17% of children had elevated blood lead levels. In communities with lower prevalences of elevated blood lead levels, universal screening may be inefficient or ineffective in improving children’s health and development; in lower prevalence communities, other strategies such as more targeted screening, reducing lead exposure sources in the environment, and educating families about lead hazards and ways to avoid them may be preferable to testing every young child for an elevated blood lead level. Additional studies to better evaluate the effectiveness and cost-effectiveness of interventions to reduce children’s blood lead levels, especially relatively low blood lead levels, are needed. 1 National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; 2 Harvard University School of Public Health