Background Over the last 20 years much has been written regarding discrepancies between the two commercially available PPD preparations in the United States. Many reports have illustrated concerns of higher rates of false-positive PPDs using the Aplisol derivative, yet hospital formulary committees continue to use this formulation.
Objective To analyze the additional costs incurred as a result of an increase in positive PPDs in the employee testing program of a hospital after the pharmacy formulary changed to Aplisol in effort to reduce costs.
Design/Setting/Participants After a significant increase over baseline in the incidence of positive PPDs in the fourth quarter of 2003 and first quarter of 2004 in the employee testing program, an investigation of the hospital infection control and facilities was initiated.
Results A total of 10 employees were investigated. Six of nine had negative PPDs on retesting using Tubersol. All underwent chest radiography that showed no evidence of tuberculosis. One testing positive on repeat PPD elected to undergo isoniazid prophylaxis. Additionally, hospital facilities management tested all negative flow and isolation rooms for compliance and changed filters in all rooms involved. Ultimately, no employees were found to have culture-proven tuberculosis, and no rooms were found to be out of compliance. Total costs associated with this investigation approached $14,000.
Conclusions As hospitals continue to struggle to provide health care at reduced costs, thorough attention to product substitutions must be given. In this example, cost savings of less than $2 per dose resulted in significant expenses to the health care system exceeding $1,300 per false-positive test. In efforts to reduce costs, hospitals should be cautious when choosing tests with a higher false-positive rate.
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