Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
The Public Health Agency of Sweden, Stockholm, Sweden.
Eur J Health Econ. 2021 Apr;22(3):445-454. doi: 10.1007/s10198-021-01265-5. Epub 2021 Feb 9.
The majority of tuberculosis (TB) cases in Sweden occur among migrants from endemic countries through activation of latent tuberculosis infection (LTBI). Sweden has LTBI-screening policies for migrants that have not been previously evaluated. This study aimed to assess the cost-effectiveness of the current screening strategy in Stockholm.
A Markov model was developed to predict the costs and effects of the current LTBI-screening program compared to a scenario of no LTBI screening over a 50-year time horizon. Epidemiological and cost data were obtained from local sources when available. The primary outcomes were incremental cost-effectiveness ratio (ICER) in terms of societal cost per quality-adjusted life year (QALY).
Screening migrants in the age group 13-19 years had the lowest ICER, 300,082 Swedish Kronor (SEK)/QALY, which is considered cost-effective in Sweden. In the age group 20-34, ICER was 714,527 SEK/QALY (moderately cost-effectives) and in all age groups above 34 ICERs were above 1,000,000 SEK/QALY (not cost-effective). ICER decreased with increasing TB incidence in country of origin.
Screening is cost-effective for young cohorts, mainly between 13 and 19, while cost-effectiveness in age group 20-34 years could be enhanced by focusing on migrants from highest incidence countries and/or by increasing the LTBI treatment initiation rate. Screening is not cost-effective in older cohorts regardless of the country of origin.
在瑞典，大多数结核病（TB）病例发生在从流行国家移民中的潜伏性结核感染（LTBI）患者中。瑞典对移民有 LTBI 筛查政策，但此前并未对此进行评估。本研究旨在评估斯德哥尔摩当前筛查策略的成本效益。
开发了一个马尔可夫模型，以预测当前 LTBI 筛查方案与不进行 LTBI 筛查方案相比，在 50 年时间内的成本效益。当可用时，从当地来源获取流行病学和成本数据。主要结果是基于社会成本的每质量调整生命年（QALY）增量成本效益比（ICER）。
对 13-19 岁年龄组的移民进行筛查，ICER 最低，为 300,082 瑞典克朗（SEK）/QALY，在瑞典被认为是具有成本效益的。在 20-34 岁年龄组中，ICER 为 714,527 SEK/QALY（中度具有成本效益），而在所有年龄组中，ICER 均高于 1,000,000 SEK/QALY（不具有成本效益）。ICER 随着原籍国的结核病发病率的增加而降低。
筛查对于年轻队列是具有成本效益的，主要是 13 至 19 岁之间的人群，而在 20-34 岁年龄组中，通过关注发病率最高的国家的移民，或通过提高 LTBI 治疗起始率，可以提高成本效益。无论原籍国如何，筛查在年龄较大的人群中都不具有成本效益。
