Setting: North American health care workers with exposure to multidrug-resistant tuberculosis.
Objective: To evaluate the relative utilities of bacille Calmette Guérin (BCG) immunization and post-infection chemoprophylaxis for the protection of health care workers exposed to multidrug-resistant Mycobacterium tuberculosis.
Design: Decision analysis using SMLTREE software and published data for probabilities.
Results: BCG vaccination was preferred by a small margin over post-infection chemoprophylaxis. Sensitivity analysis revealed that possible changes in probability values used tended to tilt the result towards use of BCG vaccination. The threshold for protective efficacy of BCG vaccination was 26%.
Conclusions: BCG vaccination should be considered for health care workers in environments where there is a substantial risk of exposure to multidrug-resistant tuberculosis.