Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2021 Nov 2;73(9):e3476-e3482. doi: 10.1093/cid/ciaa857.
Targeted testing and treatment (TTT) for latent tuberculosis (TB) infection (LTBI) is a recommended strategy to accelerate TB reductions and further TB elimination in the United States. Evidence on cost-effectiveness of TTT for key populations can help advance this goal.
We used a model of TB transmission to estimate the numbers of individuals who could be tested by interferon-γ release assay and treated for LTBI with 3 months of self-administered rifapentine and isoniazid (3HP) under various TTT scenarios. Specifically, we considered rapidly scaling up TTT among people who are non-US-born, diabetic, living with human immunodeficiency virus (HIV), homeless or incarcerated in California, Florida, New York, and Texas-states where more than half of US TB cases occur. We projected costs (from the healthcare system perspective, in 2018 dollars), 30-year reductions in TB incidence, and incremental cost-effectiveness (cost per quality-adjusted life-year [QALY] gained) for TTT in each modeled population.
The projected cost-effectiveness of TTT differed substantially by state and population, while the health impact (number of TB cases averted) was consistently greatest among non-US-born individuals. TTT was most cost-effective among persons with HIV (from $2828/QALY gained in Florida to $11 265/QALY gained in New York) and least cost-effective among people with diabetes (from $223 041/QALY gained in California to $817 753/QALY in New York).
The modeled cost-effectiveness of TTT for LTBI varies across states but was consistently greatest among people with HIV; moderate among people who are non-US-born, incarcerated, or homeless; and least cost-effective among people with diabetes.
针对潜伏性结核感染（LTBI）的目标性检测和治疗（TTT）是在美国加速结核病减少和进一步消除结核病的推荐策略。针对关键人群的 TTT 的成本效益证据可以帮助实现这一目标。
我们使用结核病传播模型来估计在各种 TTT 方案下，通过干扰素-γ释放试验检测和用 3 个月自行管理的利福喷丁和异烟肼（3HP）治疗 LTBI 的人数。具体而言，我们考虑在加利福尼亚州、佛罗里达州、纽约州和得克萨斯州（美国一半以上的结核病病例发生在这些州）迅速扩大对非美国出生、患有糖尿病、感染人类免疫缺陷病毒（HIV）、无家可归或被监禁的人群的 TTT。我们预测了每个模型人群中 TTT 的成本（从医疗保健系统的角度来看，按 2018 年的美元计算）、30 年结核病发病率的降低情况以及增量成本效益（每获得一个质量调整生命年的成本）。
TTT 的预测成本效益因州和人群而异，而对非美国出生者的健康影响（避免的结核病病例数）始终最大。在 HIV 感染者中，TTT 的成本效益最高（从佛罗里达州的每获得一个质量调整生命年 2828 美元到纽约州的每获得一个质量调整生命年 11265 美元），而在糖尿病患者中，TTT 的成本效益最低（从加利福尼亚州的每获得一个质量调整生命年 223041 美元到纽约州的每获得一个质量调整生命年 817753 美元）。
LTBI 的 TTT 的模型成本效益在各州之间有所不同，但在 HIV 感染者中始终最大；在非美国出生、被监禁或无家可归的人群中中等；在糖尿病患者中成本效益最低。
