Screening Strategies for Elevated Blood Lead Levels-Reply

Dr Andrews' central critique is that our study¹ is not a cost-benefit analysis. However, that was not our objective. Rather, we conducted a cost analysis, ie, we determined which screening strategy had the lowest cost per child screened, not whether the cost of universal screening outweighed the benefits of secondary prevention (ie, averted learning disability or school failure). We acknowledged this limitation in the next to the last paragraph of the "Comment" section, in which we cautioned against comparing the cost of selective strategies with that of universal strategies. Although the former are less expensive, elevated blood lead levels are detected in fewer children. "The question of whether the cost of missed diagnoses resulting from selective screening would be offset by the lower cost of such strategies is unresolved and would require a cost-benefit analysis."¹

Nevertheless, Dr Andrews raises a cogent point: Is universal screening for elevated blood