Yoshiyama T
Epidemiology Division, Department of Applied Research, Research Institute of Tuberculosis.
Kekkaku. 2000 Nov;75(11):629-41.
The target for isoniazid preventive therapy against tuberculosis in Japan has been contact persons of tuberculosis patients with the age of less than 30. This paper discusses about the cost effectiveness analysis of preventive therapy with the mathematical model. The effectiveness was measured with averted tuberculosis cases, averted death, averted loss of DALY (disability adjusted life years), averted loss of healthy years of life. With all indicators, isoniazid preventive therapy was effective if preventive chemotherapy is given to persons younger than 70 years old and with the higher probability of new infection than 20%, and if it is given following the present criteria of tuberculin testing for preventive therapy in Japan. The total medical cost is cheaper among persons with the preventive therapy than those without the preventive therapy, if the probability of new infection among the contact persons is more than 29% at the age of 40. The isoniazid preventive therapy for health care workers, whose prevalence of infection is higher than the average population, was also effective in both cases with and without baseline tuberculin testing. However, the positive predictive value of criteria of preventive therapy highly depends on the probability of new infection.
日本针对结核病的异烟肼预防性治疗目标人群是年龄小于30岁的结核病患者接触者。本文用数学模型讨论预防性治疗的成本效益分析。有效性通过避免的结核病例数、避免的死亡数、避免的伤残调整生命年（DALY）损失、避免的健康生命年损失来衡量。对于所有指标而言，如果对70岁以下且新感染概率高于20%的人群进行预防性化疗，并且按照日本目前预防性治疗的结核菌素检测标准进行，那么异烟肼预防性治疗是有效的。如果接触者中40岁时的新感染概率超过29%，接受预防性治疗者的总医疗费用比未接受预防性治疗者更低。对于感染率高于普通人群的医护人员，无论有无基线结核菌素检测，异烟肼预防性治疗均有效。然而，预防性治疗标准的阳性预测值高度依赖于新感染概率。
