Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Singapore.
Center for Economic and Social Research East, University of Southern California, Washington, DC, United States.
Infect Control Hosp Epidemiol. 2019 Mar;40(3):341-349. doi: 10.1017/ice.2018.334. Epub 2019 Feb 21.
To evaluate the clinical, cost-efficiency, and budgetary implications of universal versus targeted latent tuberculosis infection (LTBI) screening strategies among healthcare workers (HCWs) in an intermediate tuberculosis (TB)-burden country.
Pragmatic cost-effectiveness and budget impact analysis using decision-analytic modeling.
A tertiary-care hospital in Singapore.
We compared 7 potentially implementable LTBI screening programs including universal and targeted strategies with different screening frequencies. Feasible targeting methods included stratification by country of origin (a proxy for risk of prior TB exposure) and by high-risk occupation. The clinical and financial consequences of each strategy were estimated relative to "no screening" (current practice) and compared to locally appropriate cost-effectiveness thresholds. All analyses were conducted from the hospital's perspective over a 3-year time horizon, based on the typical hospital planning period. Parameter uncertainties were accounted for using sensitivity analyses.
In our model, relative to current practice, screening new international hires and triennial screening of existing high-risk workers is most cost-effective (US$58 per quality adjusted life year [QALY]) and decreases active TB cases from 19 to 14. Screening all new hires combined with triennial universal screening, with or without annual high-risk screening or annual universal screening, reduced active TB to a range of 19 to 6 cases, but these strategies are less cost-effective and require substantially higher expenditures.
Targeted LTBI screening for HCWs can be highly cost-effective for hospitals in settings similar to Singapore. More inclusive screening strategies (including regular universal screening) can yield better outcomes but are less efficient and may even be unaffordable.
评估在结核病负担中等的国家中，对医护人员（HCWs）进行普遍筛查与目标性筛查策略在临床效果、成本效益和预算方面的影响。
使用决策分析模型进行实用的成本效益和预算影响分析。
新加坡一家三级保健医院。
我们比较了 7 种潜在可实施的 LTBI 筛查方案，包括普遍筛查和有不同筛查频率的目标性筛查策略。可行的目标性筛查方法包括按原籍国分层（这是既往结核暴露风险的替代指标）和高风险职业分层。每种策略的临床和财务后果相对于“不筛查”（当前实践）进行了估计，并与当地适当的成本效益阈值进行了比较。所有分析均在 3 年时间范围内从医院的角度进行，基于典型的医院规划期。使用敏感性分析考虑了参数不确定性。
在我们的模型中，与当前实践相比，对新入职的国际员工进行筛查和对现有高风险员工进行三年一次的筛查是最具成本效益的（每质量调整生命年 58 美元），可将活动性结核病病例从 19 例减少到 14 例。对所有新入职员工进行筛查，再加上对所有员工进行三年一次的普遍筛查，无论是否进行年度高风险筛查或年度普遍筛查，都可将活动性结核病病例减少到 19 至 6 例，但这些策略的成本效益较低，且需要更高的支出。
针对与新加坡类似环境中的医院，医护人员的目标性 LTBI 筛查可以具有很高的成本效益。更具包容性的筛查策略（包括定期普遍筛查）可以产生更好的结果，但效率较低，甚至可能无法负担。
