Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Montpellier 1, 00185 Roma, Italy.
Int J Environ Res Public Health. 2020 Mar 5;17(5):1697. doi: 10.3390/ijerph17051697.
In the past few years, healthcare workers (HCWs) have been considered at higher risk for tuberculosis (TB) infection than the general population. On the other hand, recent studies have reported a low conversion rate among these workers. Recently, the Center for Disease Control (CDC) updated its recommendations, suggesting that an annual screening should not be performed in the absence of a documented exposure but only in workers with high-risk duties or with job tasks in settings at high risk of tuberculosis contagion (e.g., departments of infectious or pulmonary diseases). In fact, some studies showed that annual tuberculosis screening for all the HCWs was not cost-effective in countries with a low incidence of TB. In this study, we evaluated the conversion rate and the cost-effectiveness of two different tuberculosis screening strategies in a large population of Italian HCWs.
In our retrospective study, we reviewed data coming from a tuberculosis screening conducted on 1451 HCWs in a teaching hospital of Rome. All workers were evaluated annually by means of the Quantiferon test (QFT) for a five-year period. Then, the conversion rate was calculated.
We found a cumulative conversion rate of 0.6%. Considering the cost of the QFT test (48.26 euros per person), the screening of the HCWs resulted in a high financial burden (38,902.90 euros per seroconversion). Only one seroconversion would have been missed by applying the CDC updated recommendations, with a relevant drop of the costs: 6756.40 euros per seroconversion, with a global save of 296,075.10 euros.
The risk of TB conversion among our study population was extremely low and it was related to the risk classification of the setting. Giving these results, the annual tuberculosis screening appeared to not be cost effective. We conclude that a targeted screening would be a better alternative in HCWs with a higher risk of TB exposure.
在过去的几年中，与一般人群相比，医护人员（HCWs）被认为感染结核病（TB）的风险更高。另一方面，最近的研究报告称，这些工作人员的转化率较低。最近，疾病控制中心（CDC）更新了其建议，指出在没有记录暴露的情况下，不应每年进行筛查，而仅应在具有高风险职责或在结核病传染风险高的工作环境（例如传染病或肺病科）中的工作人员中进行筛查。实际上，一些研究表明，在结核病发病率较低的国家，对所有 HCWs 进行年度结核病筛查并不具有成本效益。在这项研究中，我们评估了对意大利 HCWs 进行大规模人群结核病筛查的两种不同筛查策略的转化率和成本效益。
在我们的回顾性研究中，我们审查了在罗马的一所教学医院中对 1451 名 HCWs 进行的结核病筛查的数据。所有工人在五年内每年都通过 Quantiferon 测试（QFT）进行评估。然后，计算转化率。
我们发现累积转化率为 0.6％。考虑到 QFT 测试的成本（每人 48.26 欧元），筛查 HCWs 的结果造成了很高的财务负担（每例血清转换 38902.90 欧元）。仅通过应用 CDC 更新的建议，就会错过一次血清转换，相关成本下降：每例血清转换 6756.40 欧元，总节省 296075.10 欧元。
我们研究人群中 TB 转换的风险极低，与环境的风险分类有关。根据这些结果，年度结核病筛查似乎没有成本效益。我们得出的结论是，对于具有较高 TB 暴露风险的 HCWs，有针对性的筛查将是更好的选择。
