Cost effectiveness of testing HIV infected individuals for TB in a low TB/HIV setting
Cost effectiveness of testing HIV infected individuals for TB in a low TB/HIV setting
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DOI：
10.1016/j.jinf.2020.05.055
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发表时间：
2020-08-01
影响因子：
28.2
通讯作者：
Lipman, Marc C., I
中科院分区：
文献类型：
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作者：
Capocci, Santino J.;Sewell, Janey;Lipman, Marc C., I
目的：指南推荐对HIV感染者进行潜伏性结核感染（LTBI）的常规检测。然而，在当前资源丰富、结核病/艾滋病毒发病率低的环境中，很少有成本效益研究可以证明这一点。我们试图评估潜伏性和活动性结核病检测的吸收、产量和成本效益。方法：采用分层选择的方法，前瞻性地招募在英国伦敦一家艾滋病门诊就诊的成年人，并使用症状问卷、胸片（CXR）、结核菌素皮肤试验（TST）、t点检测结核病感染。结核和诱导痰。在此基础上，采用蒙特卡洛模拟方法，对30种测试策略进行了成本-效果模型的比较，并包含了概率敏感性分析。结果：共评估219名受试者；95%的患者使用抗逆转录病毒治疗（ART）。无症状者涂片阴性、培养阳性结核病占0.9%，LTBI占9%。只有使用TST或干扰素γ释放试验（IGRA）检测撒哈拉以南非洲地区患者（无论是否使用CXR），或仅使用TST检测来自结核病发病率为40/10万的国家的患者（使用30,000磅/QALY阈值）的策略才具有成本效益。结论：对抗逆转录病毒药物使用率较高的成人HIV队列进行的成本-效果分析表明，在结核病高发病率和可能中等发病率的人群中，除了常规检测潜伏性结核病外，效益有限。(C) 2020年英国感染协会。Elsevier Ltd.出版。版权所有。
Objectives: Guidelines recommend routine testing for latent TB infection (LTBI) in people living with HIV. However there are few cost-effectiveness studies to justify this in contemporary high resource, low TB/HIV incidence settings. We sought to assess the uptake, yield and cost-effectiveness of testing for latent and active TB.Methods: Adults attending an ambulatory HIV clinic in London, UK were prospectively recruited by stratified selection and tested for TB infection using symptom questionnaires, chest radiograph (CXR), tuberculin skin test (TST), T-Spot.TB and induced sputum. From this, 30 testing strategies were compared in a cost-effectiveness model including probabilistic sensitivity analysis using Monte Carlo simulation.Results: 219 subjects were assessed; 95% were using antiretroviral therapy (ART). Smear negative, culture positive TB was present in 0.9% asymptomatic subjects, LTBI in 9%. Only strategies testing those from subSaharan Africa with a TST or interferon gamma release assay (IGRA) with or without CXR, or testing those from countries with a TB incidence of >40/100,000 with TST alone were cost-effective using a 30,000 pound/QALY threshold.Conclusions: Cost-effectiveness analysis in an adult HIV cohort with high ART usage suggests there is limited benefit beyond routine testing for latent TB in people from high and possibly medium TB incidence settings. (C) 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.