Anti-TB spending abroad could save money overall.

Investing $44 million in tuberculosis-control programs in Mexico, Haiti, and the Dominican Republic would save the United States nearly triple that amount over 20 years, according to a health-economics analysis. By minimizing the prevalence of TB abroad, the investment could reduce the burden of disease imported into the country by immigrants, refugees, illegal aliens, and visitors.

Investigators estimated the effects of TB-control programs on U.S. costs for associated illnesses and deaths using two models. In one, U.S.-government funding supports an expansion of TB treatment abroad. In the other, federal funding instead augments TB screening of applicants for legal immigration.

Spending $34.9 million on medical interventions in Mexico would result in 2,591 fewer TB cases and $108 million net savings in the United States, the researchers found. Stepped-up screening of legal Mexican immigrants, by comparison, would require $329 million to prevent 401 imported cases of TB, a huge net cost.

Similarly, a $9.4 million contribution to treatment programs in Haiti and the Dominican Republic would yield a return of $20 million over 20 years, according to the report, which appeared in the Sept. 8 New England Journal of Medicine.

Dick Menzies of McGill University in Montreal led the research team, which includes two U.S. government scientists and researchers in Mexico, Haiti, and the Dominican Republic.--B.H.