Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
St Lukes Medical Center Extension Clinic, Metro Manila, The Philippines.
Int J Tuberc Lung Dis. 2018 Apr 1;22(4):429-436. doi: 10.5588/ijtld.17.0453.
In 2007, the US Centers for Disease Control and Prevention (CDC) revised its tuberculosis (TB) technical instructions for panel physicians who administer mandatory medical examinations among US-bound immigrants. Many US-bound immigrants come from the Philippines, a high TB prevalence country.
To quantify economic and health impacts of smear- vs. culture-based TB screening.
Decision tree modeling was used to compare three Filipino screening programs: 1) no screening, 2) smear-based screening, and 3) culture-based screening. The model incorporated pre-departure TB screening results from Filipino panel physicians and CDC databases with post-arrival follow-up outcomes. Costs (2013 $US) were examined from societal, immigrant, US Public Health Department and hospitalization perspectives.
With no screening, an annual cohort of 35 722 Filipino immigrants would include an estimated 450 TB patients with 264 hospitalizations, at a societal cost of US$9.90 million. Culture-based vs. smear-based screening would result in fewer imported cases (80.9 vs. 310.5), hospitalizations (19.7 vs. 68.1), and treatment costs (US$1.57 million vs. US$4.28 million). Societal screening costs, including US follow-up, were greater for culture-based screening (US$5.98 million) than for smear-based screening (US$3.38 million). Culture-based screening requirements increased immigrant costs by 61% (US$1.7 million), but reduced costs for the US Public Health Department (22%, US$750 000) and of hospitalization (70%, US$1 020 000).
Culture-based screening reduced imported TB and US costs among Filipino immigrants.
2007 年，美国疾病控制与预防中心（CDC）修订了其面向美国入境移民体检医生的结核病（TB）技术指南。许多美国入境移民来自菲律宾，这是一个结核病高发国家。
量化基于涂片和培养的 TB 筛查的经济和健康影响。
决策树模型用于比较三种菲律宾筛查方案：1）不筛查，2）基于涂片的筛查，和 3）基于培养的筛查。该模型纳入了来自菲律宾体检医生和 CDC 数据库的出国前 TB 筛查结果以及到达后的随访结果。从社会、移民、美国公共卫生部和住院治疗的角度考察了成本（2013 年美元）。
在不筛查的情况下，每年 35722 名菲律宾移民的队列中估计有 450 名结核病患者，其中 264 人需要住院治疗，社会成本为 990 万美元。与基于涂片的筛查相比，基于培养的筛查会导致更少的输入性病例（80.9 例比 310.5 例）、住院治疗（19.7 例比 68.1 例）和治疗成本（157 万美元比 428 万美元）。包括美国随访在内的社会筛查成本，基于培养的筛查更高（598 万美元），而基于涂片的筛查较低（338 万美元）。基于培养的筛查要求增加了移民成本 61%（170 万美元），但降低了美国公共卫生部的成本（22%，75 万美元）和住院治疗成本（70%，102 万美元）。
基于培养的筛查降低了菲律宾移民中的输入性结核病和美国的成本。
