1 Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Public Health Rep. 2019 Sep/Oct;134(5):522-527. doi: 10.1177/0033354919862688. Epub 2019 Jul 24.
Tracking trends in the testing of latent tuberculosis infection (LTBI) can help measure tuberculosis elimination efforts in the United States. The objectives of this study were to estimate (1) the annual number of persons tested for LTBI and the number of LTBI tests conducted, by type of test and by public, private, and military sectors, and (2) the cost of LTBI testing in the United States.
We searched the biomedical literature for published data on private-sector and military LTBI testing in 2013, and we used back-calculation to estimate public-sector LTBI testing. To estimate costs, we applied Medicare-allowable reimbursements in 2013 by test type.
We estimated an average (low-high) 13.3 million (11.3-15.4 million) persons tested for LTBI and 15.3 million (12.9-17.7 million) LTBI tests, of which 13.2 million (11.1-15.3 million) were tuberculin skin tests and 2.1 million (1.8-2.4 million) were interferon-γ release assays (IGRAs). Eighty percent of persons tested were in the public sector, 18% were in the private sector, and 2% were in the military. Costs of LTBI tests and of chest radiography totaled $314 million (range, $256 million to $403 million).
To achieve tuberculosis elimination, millions more persons will need to be tested in all sectors. By targeting testing to only those at high risk of tuberculosis and by using more specific IGRA tests, the incidence of tuberculosis in the United States can be reduced and resources can be more efficiently used.
跟踪潜伏性结核感染（LTBI）检测趋势有助于衡量美国在结核病消除方面的努力。本研究的目的是估计（1）按检测类型以及公共、私人和军事部门划分的接受 LTBI 检测的人数和 LTBI 检测数量，以及（2）美国 LTBI 检测的费用。
我们在生物医学文献中搜索了 2013 年私人和军事部门 LTBI 检测的已发表数据，并使用回溯法估计了公共部门 LTBI 检测。为了估计费用，我们按检测类型应用了 2013 年医疗保险允许的报销额度。
我们估计平均（低值-高值）有 1330 万人（1130-1540 万人）接受 LTBI 检测，1530 万人（1290-1770 万人）接受 LTBI 检测，其中 1320 万人（1110-1530 万人）接受结核菌素皮肤试验，210 万人（180-240 万人）接受干扰素-γ释放试验（IGRAs）。接受检测的人群中 80%来自公共部门，18%来自私人部门，2%来自军事部门。LTBI 检测和胸部 X 线摄影的费用总计 3.14 亿美元（范围为 2.56 亿至 4.03 亿美元）。
为了实现结核病消除，所有部门都需要对更多的人进行检测。通过将检测目标仅针对那些有高结核病风险的人群，并使用更特异的 IGRAs 检测，美国的结核病发病率可以降低，资源可以更有效地利用。
