Modelling the cost-effectiveness of strategies to prevent tuberculosis in child contacts in a high-burden setting
Modelling the cost-effectiveness of strategies to prevent tuberculosis in child contacts in a high-burden setting
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DOI：
10.1136/thoraxjnl-2011-200933
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发表时间：
2013-03-01
期刊：
影响因子：
10
通讯作者：
Sinanovic, Edina
中科院分区：
文献类型：
--
作者：
Mandalakas, Anna M.;Hesseling, Anneke C.;Sinanovic, Edina
世卫组织建议对与传染性结核病（TB）病例密切接触的幼儿使用异烟肼预防治疗（IPT）。没有任何模型检验过这一建议的成本效益。方法建立决策分析模型，评估五种家庭接触者结核病感染筛查策略的健康和经济结果。在无测试策略中，儿童根据年龄和报告的暴露程度接受IPT。其他策略包括用结核菌素皮肤试验（TST）、干扰素检测感染。释放试验（IGRA）或TST后的IGRA。马尔可夫模型包括特定年龄的疾病状态和概率，同时考虑高负担国家的再感染风险。结果在0-2岁的队列中，不检测策略最具成本效益。每生命年节省的折后社会护理成本从237美元（不检测）到538美元（仅IGRA检测）不等。在3-5岁的队列中，TST阴性后采用IGRA的策略最有效，但与显著的增量成本相关（增量成本-效果比bbb $ 233,000），这取决于结核分枝杆菌感染率。结论幼儿结核分枝杆菌感染筛查和提供IPT是一种高性价比的干预措施。对0-2岁儿童进行不经检测的结核分枝杆菌感染筛查是最具成本效益的策略，也是3-5岁儿童的首选策略。因此，缺乏测试能力不应成为IPT交付的障碍。这些发现突出了在高负担国家对接触结核病的幼儿进行接触者追踪和IPT治疗的成本效益。
Background WHO recommends isoniazid preventive therapy (IPT) for young children in close contact with an infectious tuberculosis (TB) case. No models have examined the cost effectiveness of this recommendation.Methods A decision analysis model was developed to estimate health and economic outcomes of five TB infection screening strategies in young household contacts. In the no-testing strategy, children received IPT based on age and reported exposure. Other strategies included testing for infection with a tuberculin skin test (TST), interferon. release assay (IGRA) or IGRA after TST. Markov modelling included age-specific disease states and probabilities while considering risk of reinfection in a high-burden country.Results Among the 0-2-year-old cohort, the no-testing strategy was most cost effective. The discounted societal cost of care per life year saved ranged from US$237 (no-testing) to US$538 (IGRA only testing). Among the 3-5-year-old cohort, strategies employing an IGRA after a negative TST were most effective, but were associated with significant incremental cost (incremental cost-effectiveness ratio >US$233 000), depending on the rate of Mycobacterium tuberculosis infection.Conclusion Screening for M tuberculosis infection and provision of IPT in young children is a highly cost-effective intervention. Screening without testing for M tuberculosis infection is the most cost-effective strategy in 0-2-year-old children and the preferred strategy in 3-5-year-old children. Lack of testing capacity should therefore not be a barrier to IPT delivery. These findings highlight the cost effectiveness of contact tracing and IPT delivery in young children exposed to TB in high-burden countries.