Cost-effectiveness of Diagnostic Algorithms for Tuberculosis in Children Less Than 5 Years of Age.
Cost-effectiveness of Diagnostic Algorithms for Tuberculosis in Children Less Than 5 Years of Age.
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DOI：
10.1097/inf.0000000000001342
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发表时间：
2017-01
期刊：
影响因子：
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通讯作者：
Dowdy DW
中科院分区：
文献类型：
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作者：
Debes AK;Gilman RH;Onyango-Makumbi C;Ruff A;Oberhelman R;Dowdy DW
本分析的目的是评估使用显微镜观察药物敏感性（MODS）、Xpert MTB/RIF （Xpert）和经验性治疗对所有患者进行结核病诊断的成本效益，以及乌干达一家国家结核病转诊医院目前对5岁以下儿童的临床诊断做法。从医疗保健角度进行决策分析，主要结果增量成本效益表示为每年获得的生命成本（YLG）。算法的成本效益很大程度上取决于三个变量：结核病的患病率、结核病未经治疗的死亡概率和现有诊断算法的准确性。Xpert和MODS具有相似的成本效益概况，并且在结核病患病率和未经治疗的结核病死亡概率较低的环境中更受欢迎。随着结核病和死亡的潜在概率增加，治疗所有临床怀疑患有结核病的儿童变得更具成本效益。在未经治疗的儿童有可能死于结核病的情况下——无论是由于结核病的高流行率还是由于未经治疗的结核病的高死亡率——在开发出更好的诊断测试之前，对所有儿童进行结核病治疗可能是最具成本效益的方法。儿童结核病诊断工具的成本效益取决于人群、结核病未经治疗的自然病史和现有的诊断做法。在结核病死亡风险高的环境中，应考虑对所有结核病儿童进行经验性治疗，直到获得更敏感、成本更低的诊断检测。
The objective of this analysis was to assess the cost-effectiveness of TB diagnosis using Microscopic Observation Drug Susceptibility (MODS), Xpert MTB/RIF (Xpert), and empiric treatment for all patients, in addition to current clinical diagnostic practices in children less than 5 years of age in a national tuberculosis (TB) referral hospital in Uganda. A decision analysis was conducted from the healthcare perspective, with a primary outcome of incremental cost effectiveness expressed as cost per year of life gained (YLG). Cost-effectiveness of the algorithms depended strongly on three variables: the prevalence of TB, probability of death if TB was untreated, and accuracy of existing diagnostic algorithms. Xpert and MODS had similar cost-effectiveness profiles and were preferred in settings where the prevalence of TB and probability of death from untreated TB were low. As the underlying probability of TB disease and death increased, treating all children with clinically suspected disease became more cost-effective. In settings where the probability that an untreated child will die of TB – whether a result of high prevalence of TB or high mortality from untreated TB , treating all children for TB is likely to be the most cost-effective approach until better diagnostic tests can be developed. The cost-effectiveness of diagnostic tools for TB in children depends on the population, natural history of untreated TB, and existing diagnostic practices. In settings where the risk of TB death is high, empiric treatment of all children for TB should be considered until a more sensitive, low-cost diagnostic test is available.