Burgos J L, Kahn J G, Strathdee S A, Valencia-Mendoza A, Bautista-Arredondo S, Laniado-Laborin R, Castañeda R, Deiss R, Garfein R S
Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, California 92093-0507, USA.
Int J Tuberc Lung Dis. 2009 Aug;13(8):962-8.
To assess the cost-effectiveness of screening for latent tuberculosis infection (LTBI) using a commercially available detection test and treating individuals at high risk for human immunodeficiency virus (HIV) infection in a middle-income country.
We developed a Markov model to evaluate the cost per LTBI case detected, TB case averted and quality-adjusted life year (QALY) gained for a cohort of 1000 individuals at high risk for HIV infection over 20 years. Baseline model inputs for LTBI prevalence were obtained from published literature and cross-sectional data from tuberculosis (TB) screening using QuantiFERON-TB Gold In-Tube (QFT-GIT) testing among sex workers and illicit drug users at high risk for HIV recruited through street outreach in Tijuana, Mexico. Costs are reported in 2007 US dollars. Future costs and QALYs were discounted at 3% per year. Sensitivity analyses were performed to evaluate model robustness.
Over 20 years, we estimate the program would prevent 78 cases of active TB and 55 TB-related deaths. The incremental cost per case of LTBI detected was US$730, cost per active TB averted was US$529 and cost per QALY gained was US$108.
In settings of endemic TB and escalating HIV incidence, targeting LTBI screening and treatment among high-risk groups may be highly cost-effective.
评估在一个中等收入国家使用市售检测试验筛查潜伏性结核感染（LTBI）并治疗人类免疫缺陷病毒（HIV）感染高危个体的成本效益。
我们开发了一个马尔可夫模型，以评估在20年期间对1000名HIV感染高危个体组成的队列中，每检测出一例LTBI病例、避免一例结核病病例以及获得一个质量调整生命年（QALY）的成本。LTBI患病率的基线模型输入数据来自已发表的文献以及在墨西哥蒂华纳通过街头外展招募的高危HIV感染性工作者和吸毒者中使用全血γ干扰素释放试验（QFT-GIT）进行结核病（TB）筛查的横断面数据。成本以2007年美元报告。未来成本和QALY按每年3%进行贴现。进行敏感性分析以评估模型的稳健性。
在20年期间，我们估计该项目将预防78例活动性结核病病例和55例与结核病相关的死亡。每检测出一例LTBI病例的增量成本为730美元，每避免一例活动性结核病病例的成本为529美元，每获得一个QALY的成本为108美元。
在结核病流行且HIV发病率不断上升的情况下，针对高危人群进行LTBI筛查和治疗可能具有很高的成本效益。
