Shrestha Sourya, Cilloni Lucia, Asay Garrett R Beeler, Kammerer J Steve, Raz Kala, Shaw Tambi, Cilnis Martin, Wortham Jonathan, Marks Suzanne M, Dowdy David
Emerg Infect Dis. 2025 Mar;31(3):497-506. doi: 10.3201/eid3103.240633.
Outbreak investigation is an essential component of tuberculosis (TB) control in the United States, but its epidemiologic impact and cost-effectiveness have not been quantified. We modeled outbreak investigation activities in the United States during 2023-2032 and estimated corresponding epidemiologic impact, economic costs (in 2022 US$), and incremental cost-effectiveness ratios from the healthcare system perspective (cost per additional quality-adjusted life-year gained). We projected that outbreak investigations would result in 1,030,000 (95% uncertainty interval [UI] 376,000-1,740,000) contacts investigated, leading to 4,130 (95% UI 1,420-7,640) TB diagnoses and 104,000 (95% UI 37,600-181,000) latent TB infection diagnoses, at a total cost of US $219 million (95% UI $80-$387 million). We estimated that 5,560 (95% UI 1,720-11,400) TB cases would be averted through early detection and treatment, and the incremental cost-effectiveness of outbreak investigations, compared with no outbreak investigations, was $27,800 per quality-adjusted life-year gained (95% UI $4,580-$68,700).
疫情调查是美国结核病控制的重要组成部分，但其流行病学影响和成本效益尚未得到量化。我们对2023年至2032年期间美国的疫情调查活动进行了建模，并从医疗保健系统的角度（每获得一个额外的质量调整生命年的成本）估计了相应的流行病学影响、经济成本（以2022年美元计）和增量成本效益比。我们预计，疫情调查将导致1030000人（95%不确定区间[UI]376000 - 1740000）接受接触者调查，从而确诊4130例（95% UI 1420 - 7640）结核病和104000例（95% UI 37600 - 181000）潜伏性结核感染，总成本为2.19亿美元（95% UI 8000万 - 3.87亿美元）。我们估计，通过早期检测和治疗可避免5560例（95% UI 1720 - 11400）结核病病例，与不进行疫情调查相比，疫情调查的增量成本效益为每获得一个质量调整生命年27800美元（95% UI 4580 - 68700美元）。
