The number of privately treated tuberculosis cases in India: an estimation from drug sales data.
The number of privately treated tuberculosis cases in India: an estimation from drug sales data.
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DOI：
10.1016/s1473-3099(16)30259-6
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发表时间：
2016-11
影响因子：
56.3
通讯作者：
Dewan, Puneet
中科院分区：
文献类型：
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作者：
Arinaminpathy, Nimalan;Batra, Deepak;Khaparde, Sunil;Vualnam, Thongsuanmung;Maheshwari, Nilesh;Sharma, Lokesh;Nair, Sreenivas A.;Dewan, Puneet
了解印度私营部门管理的结核病数量对于了解该国乃至全球结核病的真正负担至关重要。在缺乏关于私人治疗患者的质量监测数据的情况下，商业药品销售数据为疾病负担估计提供了经验基础。我们使用了一个大型的、具有全国代表性的商业数据集，该数据集涉及印度189种抗结核产品的销售情况，以计算2013- 2014年私营部门的抗结核治疗量。我们使用验证研究来校正估计，该验证研究审计了针对结核病诊断的处方，并使用Monte Carlo模拟来估计不确定性。为了解决对结核病患者数量的影响，我们探讨了结核病治疗平均持续时间和私人诊断准确性的不同假设。2014年，私营部门的抗结核治疗为177.93亿患者月（95%可信区间为167.09亿至198.41亿），是公共部门的两倍。如果40-60%的私营部门结核病诊断是正确的，如果私营部门结核病治疗平均持续2-6个月，这意味着仅在2014年私营部门就治疗了119 - 534万结核病病例。这些范围的中点估计为220万例，比目前假设的高出两到三倍。印度的私营部门正在治疗大量的结核病患者，明显高于以前承认的水平。因此，加倍需要解决这一负担并加强监督。印度和全世界的结核病负担估计数需要修订。比尔和梅林达·盖茨基金会。
Understanding the amount of tuberculosis managed by the private sector in India is crucial to understanding the true burden of the disease in the country, and thus globally. In the absence of quality surveillance data on privately treated patients, commercial drug sales data offer an empirical foundation for disease burden estimation. We used a large, nationally representative commercial dataset on sales of 189 anti-tuberculosis products available in India to calculate the amount of anti-tuberculosis treatment in the private sector in 2013–14. We corrected estimates using validation studies that audited prescriptions against tuberculosis diagnosis, and estimated uncertainty using Monte Carlo simulation. To address implications for numbers of patients with tuberculosis, we explored varying assumptions for average duration of tuberculosis treatment and accuracy of private diagnosis. There were 17·793 million patient-months (95% credible interval 16·709 million to 19·841 million) of anti-tuberculosis treatment in the private sector in 2014, twice as many as the public sector. If 40–60% of private-sector tuberculosis diagnoses are correct, and if private-sector tuberculosis treatment lasts on average 2–6 months, this implies that 1·19–5·34 million tuberculosis cases were treated in the private sector in 2014 alone. The midpoint of these ranges yields an estimate of 2·2 million cases, two to three times higher than currently assumed. India's private sector is treating an enormous number of patients for tuberculosis, appreciably higher than has been previously recognised. Accordingly, there is a re-doubled need to address this burden and to strengthen surveillance. Tuberculosis burden estimates in India and worldwide require revision. Bill & Melinda Gates Foundation.