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泰国肺结核患者接触者潜伏性结核感染诊断和治疗的经济评价。

Economic evaluation of diagnosis and treatment for latent tuberculosis infection among contacts of pulmonary tuberculosis patients in Thailand.

机构信息

Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.

Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.

出版信息

Sci Rep. 2024 Jul 31;14(1):17693. doi: 10.1038/s41598-024-68452-1.

DOI:10.1038/s41598-024-68452-1
PMID:39085338
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11291668/
Abstract

Currently, interferon-gamma release assay (IGRA) is costly and not included as latent tuberculosis infection (LTBI) screening test strategy in Thailand's Universal Coverage Scheme (UCS) benefit package. The objective of this study was to assess the cost-utility of LTBI screening strategies among tuberculosis (TB) contacts in Thailand. A hybrid decision tree and Markov model was developed to compare the lifetime costs and health outcomes of tuberculin skin test (TST) and IGRA, in comparison to no screening, based on a societal perspective. Health outcomes were the total number of TB cases averted and quality-adjusted life years (QALYs), with results presented as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to explore uncertainties in all parameters. The ICER of TST compared with no screening was 27,645 baht per QALY gained, while that of IGRA compared to TST was 851,030 baht per QALY gained. In a cohort of 1000 TB contacts, both TST and IGRA strategies could avert 282 and 283 TB cases, respectively. At the Thai societal willingness-to-pay threshold of 160,000 baht per QALY gained, TST was deemed cost-effective, whereas IGRA would not be cost-effective, unless the cost of IGRA was reduced to 1,434 baht per test.

摘要

目前，干扰素释放试验（IGRA）费用高昂，并未被纳入泰国全民医疗保险计划（UCS）的潜伏性结核感染（LTBI）筛查策略中。本研究旨在评估泰国结核接触者 LTBI 筛查策略的成本效益。采用混合决策树和马尔可夫模型，从社会角度出发，比较了结核菌素皮肤试验（TST）和 IGRA 与不筛查相比，在终生成本和健康结果方面的差异。健康结果是指避免的结核病病例总数和质量调整生命年（QALY），并以增量成本效益比（ICER）表示。进行了单因素和概率敏感性分析，以探讨所有参数的不确定性。与不筛查相比，TST 的 ICER 为每获得一个 QALY 需花费 27,645 泰铢，而 IGRA 与 TST 相比，每获得一个 QALY 需花费 851,030 泰铢。在 1000 名结核接触者的队列中，TST 和 IGRA 策略分别可避免 282 例和 283 例结核病病例。在泰国社会愿意支付的每获得一个 QALY 160,000 泰铢的阈值下，TST 被认为具有成本效益，而 IGRA 则不具有成本效益，除非 IGRA 的检测费用降低至每个测试 1,434 泰铢。

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本文引用的文献

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Spatiotemporal Epidemiology of Tuberculosis in Thailand from 2011 to 2020.2011年至2020年泰国结核病的时空流行病学
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