Schwartzman Kevin, Oxlade Olivia, Barr R Graham, Grimard Franque, Acosta Ivelisse, Baez Jeannette, Ferreira Elizabeth, Melgen Ricardo Elías, Morose Willy, Salgado Arturo Cruz, Jacquet Vary, Maloney Susan, Laserson Kayla, Mendez Ariel Pablos, Menzies Dick
Respiratory Epidemiology Unit, Montreal Chest Institute, McGill University, Montreal, QC, Canada.
N Engl J Med. 2005 Sep 8;353(10):1008-20. doi: 10.1056/NEJMsa043194.
We hypothesized that investments to improve the control of tuberculosis in selected high-incidence countries would prove to be cost saving for the United States by reducing the incidence of the disease among migrants.
Using decision analysis, we estimated tuberculosis-related morbidity, mortality, and costs among legal immigrants and refugees, undocumented migrants, and temporary visitors from Mexico after their entry into the United States. We assessed the current strategy of radiographic screening of legal immigrants plus current tuberculosis-control programs alone and with the addition of either U.S.-funded expansion of the strategy of directly observed treatment, short course (DOTS), in Mexico or tuberculin skin testing to screen legal immigrants from Mexico. We also examined tuberculosis-related outcomes among migrants from Haiti and the Dominican Republic using the same three strategies.
As compared with the current strategy, expanding the DOTS program in Mexico at a cost to the United States of 34.9 million dollars would result in 2591 fewer cases of tuberculosis in the United States, with 349 fewer deaths from the disease and net discounted savings of 108 million dollars over a 20-year period. Adding tuberculin skin testing to radiographic screening of legal immigrants from Mexico would result in 401 fewer cases of tuberculosis in the United States but would cost an additional 329 million dollars. Expansion of the DOTS program would remain cost saving even if the initial investment were doubled, if the United States paid for all antituberculosis drugs in Mexico, or if the decline in the incidence of tuberculosis in Mexico was less than projected. A 9.4 million dollars investment to expand the DOTS program in Haiti and the Dominican Republic would result in net U.S. savings of 20 million dollars over a 20-year period.
U.S.-funded efforts to expand the DOTS program in Mexico, Haiti, and the Dominican Republic could reduce tuberculosis-related morbidity and mortality among migrants to the United States, producing net cost savings for the United States.
我们假设，通过降低选定高发病率国家的结核病发病率，从而减少移民中的发病数，对这些国家进行结核病控制的投入将被证明可为美国节省成本。
我们采用决策分析方法，估算了合法移民和难民、无证移民以及来自墨西哥的临时访客进入美国后的结核病相关发病率、死亡率和成本。我们评估了当前对合法移民进行射线照相筛查的策略，以及单独的当前结核病控制项目，还有加上由美国资助在墨西哥扩大直接观察短程治疗（DOTS）策略或对来自墨西哥的合法移民进行结核菌素皮肤试验后的情况。我们还使用相同的三种策略研究了来自海地和多米尼加共和国移民的结核病相关结果。
与当前策略相比，美国投入3490万美元在墨西哥扩大DOTS项目，将使美国的结核病病例减少2591例，死亡病例减少349例，在20年期间净节省折现成本1.08亿美元。在对来自墨西哥的合法移民进行射线照相筛查时增加结核菌素皮肤试验，将使美国的结核病病例减少401例，但成本将额外增加3.29亿美元。即使初始投资加倍、美国支付墨西哥所有抗结核药物费用，或者墨西哥结核病发病率的下降低于预期，扩大DOTS项目仍将节省成本。投资940万美元在海地和多米尼加共和国扩大DOTS项目，在20年期间将为美国带来2000万美元的净节省。
由美国资助在墨西哥、海地和多米尼加共和国扩大DOTS项目，可降低移民到美国后的结核病相关发病率和死亡率，为美国带来净成本节省。
