Prioritising between direct observation of therapy and case-finding interventions for tuberculosis: use of population impact measures
Prioritising between direct observation of therapy and case-finding interventions for tuberculosis: use of population impact measures
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DOI：
10.1186/1741-7015-4-35
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发表时间：
2006-12-20
期刊：
影响因子：
9.3
通讯作者：
Volmink, James A.
中科院分区：
文献类型：
--
作者：
Heller, Richard F.;Gemmell, Islay;Volmink, James A.
背景：人口影响措施(PIM)已被开发为帮助政策制定者就健康风险和利益做出与当地相关的决定的工具。这涉及评估和优先考虑在特定人群中采取干预措施的潜在益处。以印度结核病(TB)为例，我们考察了两种干预措施对人口的影响：直接观察治疗和增加病例发现。方法：使用已发表的文献和印度的国家数据计算PIM，并将其应用于10万人的假设人口。数据包括涂阳肺结核的发病率或患病率，以及因增加病例发现和使用直接观察治疗(应用于下一年的基线风险)而相对减少的风险，以及符合拟议干预措施的人口比例的增加。结果：在印度10万人口中，直接观察治疗的直接观察部分，短程(DOTS)计划可能在明年防止0.188人死于结核病，而通过增加结核病病例发现，死亡人数为1.79%。直接观察的成本(以国际美元计算)为5,960 I美元，病例发现的成本分别为4,839 I美元或31702 I美元和2,703美元。结论：在印度，增加结核病病例发现将挽救近10倍于直接观察的DOTS组成部分的生命，而每节省一条生命的成本更低。使用简单而明确的数字展示人口影响，对于政策制定者来说可能是有价值的，因为他们正在优先考虑为他们的人口进行干预。
Background: Population impact measures (PIMs) have been developed as tools to help policy-makers with locally relevant decisions over health risks and benefits. This involves estimating and prioritising potential benefits of interventions in specific populations. Using tuberculosis (TB) in India as an example, we examined the population impact of two interventions: direct observation of therapy and increasing case-finding.Methods: PIMs were calculated using published literature and national data for India, and applied to a notional population of 100 000 people. Data included the incidence or prevalence of smear-positive TB and the relative risk reduction from increasing case finding and the use of direct observation of therapy (applied to the baseline risks over the next year), and the incremental proportion of the population eligible for the proposed interventions.Results: In a population of 100 000 people in India, the directly observed component of the Directly Observed Treatment, Short-course (DOTS) programme may prevent 0.188 deaths from TB in the next year compared with 1.79 deaths by increasing TB case finding. The costs of direct observation are (in international dollars) I$ 5960 and of case finding are I$ 4839 or I$ 31702 and I$ 2703 per life saved respectively.Conclusion: Increasing case-finding for TB will save nearly 10 times more lives than will the use of the directly observed component of DOTS in India, at a smaller cost per life saved. The demonstration of the population impact, using simple and explicit numbers, may be of value to policy-makers as they prioritise interventions for their populations.