在中国引入母牛分枝杆菌菌苗及强化耐多药结核病管理策略的健康和经济影响

Health and Economic Impacts of Introducing Vaccae and Enhanced Drug-Resistant Tuberculosis Management Strategies in China.

作者信息

Zhai Pei-Yao, Zang Xiao, Jiang Ting, Feng Jian, Zhang Bin, Zhang Lei, Chen Zhi-Xian, Zhao Yan-Lin, Qin Gang

机构信息

Department of Infectious Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, Jiangsu, China.

Division of Health Policy and Management, University of Minnesota Twin Cities, Minneapolis.

出版信息

J Infect Dis. 2025 Jun 2;231(5):1271-1280. doi: 10.1093/infdis/jiae590.

DOI:10.1093/infdis/jiae590

PMID:39576253

Abstract

BACKGROUND

China faces high burden of multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB). We aimed to evaluate the impacts of Vaccae vaccination and enhanced drug-resistant TB (DR-TB) management strategies.

METHODS

Using a compartmental model calibrated with national TB data, we evaluated 9 interventions: enhanced DR-TB management (S1); Vaccae vaccination for those with latent TB infection, targeting specific age groups (S2: adolescents, S3: adolescents and young adults, S4: working-age adults, S5: elderly); and combined strategies S6-S9. Vaccae's efficacy was 0.547 for the first 5 years, then waning annually. Costs were US$28/dose for Vaccae, US$87/test for Xpert MTB/RIF, and US$13 818/course for BPaLM.

RESULTS

Strategy S1 is projected to reduce MDR/RR-TB incidence and mortality by 21% (95% UI, 8%-46%) and 54% (38%-67%), respectively, by 2050. Strategy S9 (S5+S1) is more effective, reducing the incidence by 44% (35%-61%) and mortality by 68% (52%-78%), with an ICER of US$7222 (4460-10 779) per DALY averted compared with S1. Additionally, S9 could prevent 24.2 (13.5-32.9) million patient-months of second-line treatment from 2025 to 2050.

CONCLUSIONS

Prioritizing Vaccae vaccination for the elderly and enhancing DR-TB management offer a promising and cost-effective opportunity for China. The findings may have policy implications for other low- and middle-income countries with high MDR/RR-TB burden.

摘要

背景

中国面临耐多药或利福平耐药结核病（MDR/RR-TB）的高负担。我们旨在评估微卡疫苗接种和强化耐药结核病（DR-TB）管理策略的影响。

方法

使用根据国家结核病数据校准的分区模型，我们评估了9种干预措施：强化DR-TB管理（S1）；针对潜伏性结核感染人群、针对特定年龄组的微卡疫苗接种（S2：青少年，S3：青少年和青年成年人，S4：工作年龄成年人，S5：老年人）；以及联合策略S6-S9。微卡疫苗在前5年的效力为0.547，然后逐年下降。微卡疫苗每剂成本为28美元，Xpert MTB/RIF检测每次87美元，BPaLM疗程每疗程13818美元。

结果

预计到2050年，策略S1将使MDR/RR-TB发病率和死亡率分别降低21%（95%UI，8%-46%）和54%（38%-67%）。策略S9（S5+S1）更有效，发病率降低44%（35%-61%），死亡率降低68%（52%-78%），与S1相比，每避免一个伤残调整生命年的增量成本效果比为7222美元（4460-10779美元）。此外，S9从2025年到2050年可预防2420万（1350-3290万）患者月的二线治疗。