The global impact of household contact management for children on multidrug-resistant and rifampicin-resistant tuberculosis cases, deaths, and health-system costs in 2019: a modelling study.
The global impact of household contact management for children on multidrug-resistant and rifampicin-resistant tuberculosis cases, deaths, and health-system costs in 2019: a modelling study.
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2019年儿童家庭接触管理对耐多药和耐利福平结核病病例、死亡和卫生系统成本的全球影响：一项模型研究
DOI：
10.1016/s2214-109x(22)00113-9
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发表时间：
2022-07
影响因子：
34.3
通讯作者：
McQuaid, Christopher F.
中科院分区：
文献类型：
--
作者：
Dodd, Peter J.;Mafirakureva, Nyashadzaishe;Seddon, James A.;McQuaid, Christopher F.
据估计，每年至少有3万名儿童患上耐多药或耐利福平结核病。尽管家庭接触管理（HCM）被广泛推荐，但很少有人这样做。我们使用数学建模来评估耐多药或耐利福平结核病HCM对与新诊断的耐多药或耐利福平结核病患者一起生活的15岁以下儿童的潜在国家和全球影响和成本效益。我们比较了无HCM的基线与几种HCM策略和结核病预防治疗方案，计算了对耐多药或耐利福平结核病病例、死亡和卫生系统成本的影响。所有HCM策略均涉及筛查儿童的流行结核病，但根据年龄、HIV状态和结核菌素皮肤试验结果，未给予或有针对性地给予结核病预防性治疗。我们评价了氟喹诺酮类药物（即左氧氟沙星和氟喹诺酮类药物）、地拉曼尼和贝达喹啉作为结核病预防治疗的应用。与没有HCM的基线相比，2019年诊断为耐多药或耐利福平结核病的所有成人的HCM将需要筛查227，000名儿童（95%不确定区间[UI]：205 000-252 000），避免了2350例结核病死亡（1940-2790），额外花费63百万美元（74-95百万）。如果家庭中所有与耐多药或耐利福平结核病患者接触的儿童接受左氧氟沙星结核病预防治疗，则可预防5620例结核病发病（95% UI 4540-6890）和另外1240例死亡（970-1540）。在大多数国家，大多数干预措施的增量成本效益比低于人均国内生产总值的一半。仅针对5岁以下儿童和艾滋病毒感染者，减少了发病病例数，避免了死亡，但提高了成本效益。与左氧氟沙星相比，德拉马尼预防性治疗结核病在降低发病率和死亡率方面增加了效果。对耐多药或耐利福平结核病患者进行HCM在大多数情况下具有成本效益，可以避免全球儿童中相当大比例的耐多药或耐利福平结核病病例和死亡。英国医学研究理事会。
Estimates suggest that at least 30 000 children develop multidrug-resistant or rifampicin-resistant tuberculosis each year. Despite household contact management (HCM) being widely recommended, it is rarely done. We used mathematical modelling to evaluate the potential country-level and global effects and cost-effectiveness of multidrug-resistant or rifampicin-resistant tuberculosis HCM for children younger than 15 years who are living with a person with newly diagnosed multidrug-resistant or rifampicin-resistant tuberculosis. We compared a baseline of no HCM with several HCM strategies and tuberculosis preventive therapy regimens, calculating the effect on multidrug-resistant or rifampicin-resistant tuberculosis cases, deaths, and health-system costs. All HCM strategies involved the screening of children for prevalent tuberculosis disease but with tuberculosis preventive therapy either not given or targeted dependent on age, HIV status, and result of tuberculin skin test. We evaluated the use of fluoroquinolones (ie, levofloxacin and moxifloxacin), delamanid, and bedaquiline as tuberculosis preventive therapy. Compared with a baseline without HCM, HCM for all adults diagnosed with multidrug-resistant or rifampicin-resistant tuberculosis in 2019 would have entailed screening 227 000 children (95% uncertainty interval [UI]: 205 000–252 000) younger than 15 years globally, and averted 2350 tuberculosis deaths (1940–2790), costing an additional US$63 million (74–95 million). If all the children within the household who had been in contact with the person with multidrug-resistant or rifampicin-resistant tuberculosis received tuberculosis preventive therapy with levofloxacin, 5620 incident tuberculosis cases (95% UI 4540–6890) and an additional 1240 deaths (970–1540) would have been prevented. Incremental cost-effectiveness ratios were lower than half of per-capita gross domestic product for most interventions in most countries. Targeting only children younger than 5 years and those living with HIV reduced the number of incident cases and deaths averted, but improved cost-effectiveness. Tuberculosis preventive therapy with delamanid increased the effect, in terms of reduced incidence and mortality, compared with levofloxacin. HCM for patients with multidrug-resistant or rifampicin-resistant tuberculosis is cost-effective in most settings and could avert a substantial proportion of multidrug-resistant or rifampicin-resistant tuberculosis cases and deaths in children globally. UK Medical Research Council.