Model-based Cost-effectiveness of State-level Latent Tuberculosis Interventions in California, Florida, New York, and Texas.
Model-based Cost-effectiveness of State-level Latent Tuberculosis Interventions in California, Florida, New York, and Texas.
复制标题
DOI：
10.1093/cid/ciaa857
复制
发表时间：
2021-11-02
期刊：
影响因子：
--
通讯作者：
Dowdy D
中科院分区：
文献类型：
--
作者：
Jo Y;Shrestha S;Gomes I;Marks S;Hill A;Asay G;Dowdy D
针对潜在结核病感染(LTBI)的靶向检测和治疗(TTT)是在美国加速结核病减少和进一步消除结核病的推荐策略。TTT对关键人群的成本效益证据有助于推进这一目标。我们使用结核病传播模型来估计在不同的γ方案下，可以通过干扰素释放试验(IGRA)检测并接受利福喷丁和异烟肼(3HP)3个月自我给药的长期脑损伤治疗的人数。具体地说，我们考虑在加利福尼亚州、佛罗里达州、纽约州和德克萨斯州--美国一半以上的结核病病例发生在这些州--的非美国出生、糖尿病、艾滋病毒阳性、无家可归或被监禁的人中迅速扩大TTT。我们预测了TTT在每个建模人群中的成本(从医疗系统角度来看，以2018美元为单位)、结核病发病率30年的降低以及增量成本效益(每质量调整生命年[QALY]的成本)。TTT的预计成本效益因州和人口的不同而有很大差异，而对健康的影响(避免结核病病例的数量)在非美国出生的人中始终是最大的。TTT在艾滋病毒携带者中成本效益最高(从佛罗里达州的2,828美元/QALY增加到纽约的11,265美元/QALY)，而在糖尿病患者中成本效益最低(从加利福尼亚州的223,041美元/QALY增加到纽约的817,753美元/QALY)。TTT对LTBI的建模成本效益因州而异，但在艾滋病毒携带者中始终是最高的，在非美国出生、被监禁或无家可归的人中中等，在糖尿病患者中成本效益最低。TTT治疗LTBI的成本效益因州而异，但在艾滋病毒携带者中最高，在非美国出生、被监禁或无家可归的人中中等，在糖尿病患者中成本效益最低。
Targeted testing and treatment (TTT) for latent tuberculosis infection (LTBI) is a recommended strategy to accelerate TB reductions and further tuberculosis elimination in the United States (US). Evidence on cost-effectiveness of TTT for key populations can help advance this goal. We used a model of TB transmission to estimate the numbers of individuals who could be tested by interferon-γ release assay (IGRA) and treated for LTBI with three months of self-administered rifapentine and isoniazid (3HP) under various TTT scenarios. Specifically, we considered rapidly scaling up TTT among people who are non-US-born, diabetic, HIV-positive, homeless or incarcerated in California, Florida, New York, and Texas – states where more than half of US TB cases occur. We projected costs (from the healthcare system perspective, in 2018 dollars), thirty-year reductions in TB incidence, and incremental cost effectiveness (cost per quality-adjusted life year [QALY] gained) for TTT in each modeled population. The projected cost effectiveness of TTT differed substantially by state and population, while the health impact (number of TB cases averted) was consistently greatest among the non-US-born. TTT was most cost-effective among persons living with HIV (from $2,828/QALY gained in Florida to $11,265/QALY gained in New York) and least cost-effective among people with diabetes (from $223,041/QALY gained in California to $817,753 /QALY in New York). The modeled cost-effectiveness of TTT for LTBI varies across states but was consistently greatest among people living with HIV, moderate among people who are non-US-born, incarcerated, or homeless, and least cost-effective among people living with diabetes. The cost-effectiveness of TTT for LTBI varies across states but was greatest among people living with HIV, moderate among people who are non-US-born, incarcerated, or homeless, and least cost effective among people living with diabetes.
登录
查看更多内容
DOI：
10.5588/ijtld.15.1001
发表时间：
2016-07-01
影响因子：
4
作者：
Castro, K. G.;Marks, S. M.;LoBue, P. A.
通讯作者：
LoBue, P. A.
影响因子：
39
作者：
Tasillo, Abriana;Salomon, Joshua A.;Linas, Benjamin P.
通讯作者：
Linas, Benjamin P.
影响因子：
34.3
作者：
Salomon, Joshua A.;Haagsma, Juanita A.;Vos, Theo
通讯作者：
Vos, Theo
影响因子：
3.7
作者：
Sandgren A;Vonk Noordegraaf-Schouten M;van Kessel F;Stuurman A;Oordt-Speets A;van der Werf MJ
通讯作者：
van der Werf MJ
影响因子：
5
作者：
Shea KM;Kammerer JS;Winston CA;Navin TR;Horsburgh CR Jr
通讯作者：
Horsburgh CR Jr