Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC, Canada.
Eur Respir J. 2012 Mar;39(3):626-34. doi: 10.1183/09031936.00065311. Epub 2011 Aug 4.
Drug-resistant tuberculosis (TB) is a serious emerging problem in many low-resource countries. TB control programmes are uncertain of which drug susceptibility tests (DSTs) to use and when to test patients. We predicted the potential cost-effectiveness of different DST strategies, in settings with varying prevalence of drug resistance. Using decision analysis, we assessed the cost-effectiveness of conventional and rapid DSTs for previously diagnosed smear-positive TB cases. Five different time-points were considered for administering DSTs. Different initial drug resistance and HIV scenarios were also considered. All DST scenarios in the wide range of settings considered were found to be cost-effective. The strategy of performing a rapid DST that detects any form of isoniazid (INH) and rifampicin (RIF) resistance for all patients before the initiation of treatment was predicted to be the most cost-effective strategy. In a setting with moderate drug resistance, the cost per disability-adjusted life year gained was as low as US$744. Our findings support the roll-out of rapid drug susceptibility testing at the moment of diagnosis to detect any form of INH and RIF resistance in all countries with moderate or greater burdens of drug-resistant TB.
耐药结核病（TB）是许多资源匮乏国家面临的一个严重新问题。结核病控制规划不确定应使用哪种药物敏感性测试（DST）以及何时对患者进行检测。我们预测了不同 DST 策略在耐药率不同的情况下的潜在成本效益。使用决策分析，我们评估了传统和快速 DST 对先前诊断为痰涂片阳性的 TB 病例的成本效益。考虑了五个不同的时间点进行 DST。还考虑了不同的初始药物耐药性和 HIV 情况。在所考虑的各种情况下，所有 DST 方案均具有成本效益。在开始治疗之前，对所有患者进行快速 DST 检测，以检测任何形式的异烟肼（INH）和利福平（RIF）耐药性的策略被预测为最具成本效益的策略。在耐药程度中等的环境中，每获得一个残疾调整生命年的成本低至 744 美元。我们的研究结果支持在所有中高耐药结核病负担的国家，在诊断时推出快速药物敏感性测试，以检测任何形式的 INH 和 RIF 耐药性。
