Haukaas Fredrik Salvesen, Arnesen Trude Margrete, Winje Brita Askeland, Aas Eline
Domain for Infection Control and Environmental Health, Norwegian Institute of Public Health, PO Box 4404 Nydalen, Oslo, Norway.
Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo, Postboks 1089, 0317, Blindern, Norway.
Eur J Health Econ. 2017 May;18(4):405-415. doi: 10.1007/s10198-016-0779-0. Epub 2016 Mar 12.
The incidence of tuberculosis (TB) disease has increased in Norway since the mid-1990s. Immigrants are screened, and some are treated, for latent TB infection (LTBI) to prevent TB disease (reactivation). In this study, we estimated the costs of both treating and screening for LTBI and TB disease, which has not been done previously in Norway. We developed a model to indicate the cost-effectiveness of four different screening algorithms for LTBI using avoided TB disease cases as the health outcome. Further, we calculated the expected value of perfect information (EVPI), and indicated areas of LTBI screening that could be changed to improve cost-effectiveness. The costs of treating LTBI and TB disease were estimated to be €1938 and €15,489 per case, respectively. The model evaluates four algorithms, and suggests three cost-effective algorithms depending on the cost-effectiveness threshold. Screening all immigrants with interferon-gamma release assays (IGRA) requires the highest threshold (€28,400), followed by the algorithms "IGRA on immigrants with risk factors" and "no LTBI screening." EVPI is approximately €5 per screened immigrant. The costs for a cohort of 20,000 immigrants followed through 10 years range from €12.2 million for the algorithm "screening and treatment for TB disease but no LTBI screening," to €14 million for "screening all immigrants for both TB disease and LTBI with IGRA." The results suggest that the cost of TB disease screening and treatment is the largest contributor to total costs, while LTBI screening and treatment costs are relatively small. Increasing the proportion of IGRA-positive immigrants who are treated decreases the costs per avoided case substantially.
自20世纪90年代中期以来，挪威结核病（TB）的发病率有所上升。对移民进行潜伏性结核感染（LTBI）筛查，并对部分患者进行治疗，以预防结核病（复发）。在本研究中，我们估算了治疗和筛查LTBI及结核病的成本，此前挪威尚未开展此类研究。我们开发了一个模型，以避免的结核病病例数作为健康结果，来表明四种不同LTBI筛查算法的成本效益。此外，我们计算了完美信息的期望值（EVPI），并指出了LTBI筛查中可改变的领域，以提高成本效益。治疗LTBI和结核病的成本估计分别为每例1938欧元和15489欧元。该模型评估了四种算法，并根据成本效益阈值提出了三种具有成本效益的算法。对所有移民进行干扰素-γ释放试验（IGRA）筛查需要最高阈值（28400欧元），其次是“对有风险因素的移民进行IGRA筛查”和“不进行LTBI筛查”这两种算法。EVPI约为每位接受筛查的移民5欧元。对20000名移民进行为期10年的跟踪，成本范围从“结核病筛查和治疗但不进行LTBI筛查”算法的1220万欧元，到“用IGRA对所有移民进行结核病和LTBI筛查”算法的1400万欧元。结果表明，结核病筛查和治疗成本是总成本的最大组成部分，而LTBI筛查和治疗成本相对较小。增加接受治疗的IGRA阳性移民比例可大幅降低每例避免病例的成本。
