Jo Youngji, Gomes Isabella, Flack Joseph, Salazar-Austin Nicole, Churchyard Gavin, Chaisson Richard E, Dowdy David W
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
EClinicalMedicine. 2021 Jan 7;31:100707. doi: 10.1016/j.eclinm.2020.100707. eCollection 2021 Jan.
While household contact investigation is widely recommended as a means to reduce the burden of tuberculosis (TB) among children, only 27% of eligible pediatric household contacts globally received preventive treatment in 2018. We assessed the cost-effectiveness of household contact investigation for TB treatment and short-course preventive therapy provision for children under 15 years old across 12 high TB burden countries.
We used decision analysis to compare the costs and estimated effectiveness of three intervention scenarios: (a) status quo (existing levels of coverage with isoniazid preventive therapy), (b) contact investigation with treatment of active TB but no additional preventive therapy, and (c) contact investigation with TB treatment and provision of short-course preventive therapy. Using country-specific demographic, epidemiological and cost data from the literature, we estimated annual costs (in 2018 USD) and the number of TB cases and deaths averted across 12 countries. Incremental cost effectiveness ratios were assessed as cost per death and per disability-adjusted life year [DALY] averted.
Our model estimates that contact investigation with treatment of active TB and provision of preventive therapy could be highly cost-effective compared to the status quo (ranging from $100 per DALY averted in Malawi to $1,600 in Brazil; weighted average $383 per DALY averted [uncertainty range: $248 - $1,130]) and preferred to contact investigation without preventive therapy (weighted average $751 per DALY averted [uncertainty range: $250 - $1,306]). Key drivers of cost-effectiveness were TB prevalence, sensitivity of TB diagnosis, case fatality for untreated TB, and cost of household screening.
Based on this modeling analysis of available published data, household contact investigation with provision of short-course preventive therapy for TB has a value-for-money profile that compares favorably with other interventions.
Unitaid (2017-20-IMPAACT4TB).
虽然家庭接触者调查作为减轻儿童结核病负担的一种手段被广泛推荐，但2018年全球只有27%符合条件的儿童家庭接触者接受了预防性治疗。我们评估了12个结核病高负担国家针对15岁以下儿童进行家庭接触者调查以提供结核病治疗和短程预防性治疗的成本效益。
我们采用决策分析来比较三种干预方案的成本和估计效果：(a) 现状（异烟肼预防性治疗的现有覆盖水平），(b) 进行接触者调查并治疗活动性结核病但不提供额外预防性治疗，以及(c) 进行接触者调查并治疗结核病且提供短程预防性治疗。利用文献中各国特定的人口、流行病学和成本数据，我们估计了12个国家的年度成本（以2018年美元计）以及避免的结核病病例数和死亡数。增量成本效益比按避免每例死亡和每例伤残调整生命年（DALY）的成本进行评估。
我们的模型估计，与现状相比，进行活动性结核病治疗并提供预防性治疗的接触者调查可能具有很高的成本效益（从马拉维每避免一个DALY花费100美元到巴西的1600美元不等；加权平均每避免一个DALY花费383美元[不确定性范围：248 - 1130美元]），并且优于不进行预防性治疗的接触者调查（加权平均每避免一个DALY花费751美元[不确定性范围：250 - 1306美元]）。成本效益的关键驱动因素是结核病患病率、结核病诊断的敏感性、未治疗结核病的病死率以及家庭筛查成本。
基于对现有已发表数据的这种建模分析，对结核病进行家庭接触者调查并提供短程预防性治疗具有性价比优势，与其他干预措施相比更具优势。
国际药品采购机制（2017 - 20 - IMPAACT4TB）。
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