Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review.
Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review.
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DOI：
10.1186/s12879-021-06633-3
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发表时间：
2021-09-08
影响因子：
3.7
通讯作者：
Zwerling A
中科院分区：
文献类型：
--
作者：
Alsdurf H;Empringham B;Miller C;Zwerling A
活动性结核病 (TB) 的系统筛查是一项策略，要求卫生系统寻找个体，而不是等待个体自我出现症状（即被动发现病例）。我们的审查旨在总结当前的经济证据，并了解高风险群体和环境中系统筛查方法的成本和成本效益。我们对针对具有临床和/或结构性危险因素的人群（例如艾滋病毒感染者（PLHIV）或无家可归者）进行结核病筛查的经济评估进行了系统回顾。我们检索了三个数据库，查找 2010 年 1 月 1 日至 2020 年 2 月 1 日期间发表的研究。如果研究报告了成本和关键结果指标，则将其纳入其中。由于设置和筛选策略类型存在相当大的异质性，我们描述性地合成了数据。我们的评论总共收录了 27 篇文章； 19/27 (70%) 发生在结核病高负担国家。 17 项研究针对具有临床危险因素的人群，其中 14 项研究针对 PLHIV，而 13 项研究针对具有结构性危险因素的人群。九项研究报告称，每避免残疾调整生命年 (DALY)，增量成本效益比 (ICER) 范围为 51 美元至 1980 美元。在艾滋病毒感染者中，筛查最具成本效益。在具有临床和结构性危险因素的人群中，证据有限，但筛查通常不具有成本效益。研究表明，在结核病高流行人群中，筛查最有可能具有成本效益。我们的审查强调，要覆盖“失踪的数百万”结核病计划，应重点关注简单、廉价的初步筛查工具（即症状筛查和 CXR），然后是当地环境中最高风险群体（即艾滋病毒携带者、城市贫民窟）中的分子诊断工具（即 Xpert®）。计划成本极大地影响成本效益，因此未来的研究应提供筛选干预措施的固定成本和可变成本，以提高可比性。在线版本包含可在 10.1186/s12879-021-06633-3 获取的补充材料。
Systematic screening for active tuberculosis (TB) is a strategy which requires the health system to seek out individuals, rather than waiting for individuals to self-present with symptoms (i.e., passive case finding). Our review aimed to summarize the current economic evidence and understand the costs and cost-effectiveness of systematic screening approaches among high-risk groups and settings. We conducted a systematic review on economic evaluations of screening for TB disease targeting persons with clinical and/or structural risk factors, such as persons living with HIV (PLHIV) or persons experiencing homelessness. We searched three databases for studies published between January 1, 2010 and February 1, 2020. Studies were included if they reported cost and a key outcome measure. Owing to considerable heterogeneity in settings and type of screening strategy, we synthesized data descriptively. A total of 27 articles were included in our review; 19/27 (70%) took place in high TB burden countries. Seventeen studies took place among persons with clinical risk factors, including 14 among PLHIV, while 13 studies were among persons with structural risk factors. Nine studies reported incremental cost-effectiveness ratios (ICERs) ranging from US$51 to $1980 per disability-adjusted life year (DALY) averted. Screening was most cost-effective among PLHIV. Among persons with clinical and structural risk factors there was limited evidence, but screening was generally not shown to be cost-effective. Studies showed that screening is most likely to be cost-effective in a high TB prevalence population. Our review highlights that to reach the “missing millions” TB programmes should focus on simple, cheaper initial screening tools (i.e., symptom screen and CXR) followed by molecular diagnostic tools (i.e., Xpert®) among the highest risk groups in the local setting (i.e., PLHIV, urban slums). Programmatic costs greatly impact cost-effectiveness thus future research should provide both fixed and variable costs of screening interventions to improve comparability. The online version contains supplementary material available at 10.1186/s12879-021-06633-3.
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影响因子：
15.1
作者：
Cilloni L;Fu H;Vesga JF;Dowdy D;Pretorius C;Ahmedov S;Nair SA;Mosneaga A;Masini E;Sahu S;Arinaminpathy N
通讯作者：
Arinaminpathy N
影响因子：
3.7
作者：
Jo, Youngji;Mirzoeva, Farangiz;Sohn, Hojoon
通讯作者：
Sohn, Hojoon
DOI：
10.1183/09031936.00070812
发表时间：
2013-01
期刊：
The European respiratory journal
影响因子：
--
作者：
Fox GJ;Barry SE;Britton WJ;Marks GB
通讯作者：
Marks GB
影响因子：
11.8
作者：
Bassett, Ingrid V.;Wang, Bingxia;Freedberg, Kenneth A.
通讯作者：
Freedberg, Kenneth A.
影响因子：
4.5
作者：
Husereau, Don;Drummond, Michael;Loder, Elizabeth
通讯作者：
Loder, Elizabeth