How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India.
How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India.
复制标题
DOI：
10.1186/s12916-014-0216-0
复制
发表时间：
2014-10-30
期刊：
影响因子：
9.3
通讯作者：
Dowdy DW
中科院分区：
文献类型：
--
作者：
Azman AS;Golub JE;Dowdy DW
目前的方法不太可能实现为2035年及以后设定的积极的全球结核病控制目标。积极的情况下发现（ACF）可能是一个重要的工具，以加强现有的战略，但ACF的成本效益仍然不确定。项目评估人员通常可以衡量每个结核病例的ACF成本，但这种可获得的衡量标准如何转化为传统的成本效益指标，如每残疾调整生命年（DALY）的成本，目前尚不清楚。我们在印度、中国和南非构建了结核病动态模型，以探索通用ACF活动的中期影响和成本效益，这些活动分别被概念化为离散（2年）活动和整合到正在进行的结核病控制项目中的连续活动。我们的主要结果是每DALY的成本，与每例主动发现并开始治疗的结核病病例的成本相关。成本高达1，200美元的离散活动（95%不确定性范围[UR] 850- 2，043）在印度主动发现并开始治疗的每例病例，3，800美元（95% UR 2，706 - 6，392）在中国，和9，400美元在南非，95%（6，957 - 13，221乌拉圭比索）的人均收入都具有很高的成本效益（避免的每DALY成本低于人均国内生产总值）。长期一体化甚至更有效，更具成本效益。ACF的短期评估大大低估了潜在的长期收益;例如，对ACF项目的2年评估可能会发现患病率降低11%，但对同一干预措施的10年评估将显示降低33%。活性炭纤维可以成为一个强大的和高度成本效益的工具，在打击结核病。鉴于短期评估可能大大低估中期效力，目前的支付意愿可能太低。在大多数高负担环境中，ACF应作为结核病控制的基本工具得到大力考虑，即使对每一例额外的活动性结核病病例进行检测和开始治疗的费用可能超过1，000美元。本文的在线版本（doi：10.1186/s12916-014-0216-0）包含补充材料，可供授权用户使用。
Current approaches are unlikely to achieve the aggressive global tuberculosis (TB) control targets set for 2035 and beyond. Active case finding (ACF) may be an important tool for augmenting existing strategies, but the cost-effectiveness of ACF remains uncertain. Program evaluators can often measure the cost of ACF per TB case detected, but how this accessible measure translates into traditional metrics of cost-effectiveness, such as the cost per disability-adjusted life year (DALY), remains unclear. We constructed dynamic models of TB in India, China, and South Africa to explore the medium-term impact and cost-effectiveness of generic ACF activities, conceptualized separately as discrete (2-year) campaigns and as continuous activities integrated into ongoing TB control programs. Our primary outcome was the cost per DALY, measured in relationship to the cost per TB case actively detected and started on treatment. Discrete campaigns costing up to $1,200 (95% uncertainty range [UR] 850–2,043) per case actively detected and started on treatment in India, $3,800 (95% UR 2,706–6,392) in China, and $9,400 (95% UR 6,957–13,221) in South Africa were all highly cost-effective (cost per DALY averted less than per capita gross domestic product). Prolonged integration was even more effective and cost-effective. Short-term assessments of ACF dramatically underestimated potential longer term gains; for example, an assessment of an ACF program at 2 years might find a non-significant 11% reduction in prevalence, but a 10-year evaluation of that same intervention would show a 33% reduction. ACF can be a powerful and highly cost-effective tool in the fight against TB. Given that short-term assessments may dramatically underestimate medium-term effectiveness, current willingness to pay may be too low. ACF should receive strong consideration as a basic tool for TB control in most high-burden settings, even when it may cost over $1,000 to detect and initiate treatment for each extra case of active TB. The online version of this article (doi:10.1186/s12916-014-0216-0) contains supplementary material, which is available to authorized users.
登录
查看更多内容
结核病的自然病史：艾滋病毒阴性患者未经治疗的肺结核的持续时间和死亡：系统评价。
影响因子：
3.7
作者：
Tiemersma EW;van der Werf MJ;Borgdorff MW;Williams BG;Nagelkerke NJ
通讯作者：
Nagelkerke NJ
影响因子：
120.7
作者：
Havlir, Diane V.;Getahun, Haileyesus;Nunn, Paul
通讯作者：
Nunn, Paul
影响因子：
168.9
作者：
Dye, C;Garnett, GP;Williams, BG
通讯作者：
Williams, BG
影响因子：
168.9
作者：
Ayles, Helen;Muyoyeta, Monde;Godfrey-Faussett, Peter
通讯作者：
Godfrey-Faussett, Peter
影响因子：
168.9
作者：
Corbett, Elizabeth L.;Bandason, Tsitsi;Duong, Trinh;Dauya, Ethel;Makamure, Beauty;Churchyard, Gavin J.;Williams, Brian G.;Munyati, Shungu S.;Butterworth, Anthony E.;Mason, Peter R.;Mungofa, Stanley;Hayes, Richard J.
通讯作者：
Hayes, Richard J.