Cost-effectiveness of post-treatment follow-up examinations and secondary prevention of tuberculosis in a high-incidence setting: a model-based analysis.
Cost-effectiveness of post-treatment follow-up examinations and secondary prevention of tuberculosis in a high-incidence setting: a model-based analysis.
复制标题
高发环境下结核病治疗后随访检查和二级预防的成本效益：一项基于模型的分析。
DOI：
10.1016/s2214-109x(20)30227-8
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Yaesoubi R
中科院分区：
文献类型：
--
作者：
Marx FM;Cohen T;Menzies NA;Salomon JA;Theron G;Yaesoubi R
在结核病发病率高的情况下，以前接受过治疗的个人仍然有很高的结核病复发风险，并大大增加了总体疾病负担。尚未确定在以前接受过治疗的人中发现结核病病例和采取预防性干预措施是否具有成本效益。我们的目的是估计每年治疗后随访检查和二级预防治疗结核病在结核病流行的环境中的成本和健康效益。我们开发了一个传播动态数学模型，并将其校准为南非开普敦郊区两个约40000人的高发社区的数据。我们使用该模型来估计完成结核病治疗的个体中与年度随访检查和二级异烟肼预防性治疗（IPT）（单独和联合）相关的总成本和残疾调整生命年（DIMs）。我们调查了这些干预措施仅限于治疗完成后第一年或无限期延长的情况。对于每一种干预方案，我们预测了卫生系统成本和相对于结核病控制现状避免的结核病。所有估计值均来自10年（2019- 2028年）模拟的1000个流行病轨迹的平均值，95%的不确定性区间（UI）计算为第2.5和第97.5百分位值。我们估计，在治疗完成后第一年结束时进行一次随访检查，结合12个月的二次IPT，将在10年内避免2472例DADs（95% UI-888至7801），预计与目前的控制措施相比，将节省成本。持续的年度随访和治疗后第一年后的连续二次IPT将在10年内避免额外的1179 DALY（-1769至4377），预计每避免DALY的额外成本为18.2美元。包括二次IPT的策略占主导地位的后续战略没有二次IPT（即，预计会导致更低的健康影响，成本更高）。在这种高发病率环境下，治疗后随访和二级预防治疗可以加速结核病发病率的下降，并可能节省结核病控制资源。需要进行经验性试验，以评估这些干预措施在受结核病影响最严重的环境中的可行性。
In settings of high tuberculosis incidence, previously treated individuals remain at high risk of recurrent tuberculosis and contribute substantially to overall disease burden. Whether tuberculosis case finding and preventive interventions among previously treated people are cost-effective has not been established. We aimed to estimate costs and health benefits of annual post-treatment follow-up examinations and secondary preventive therapy for tuberculosis in a tuberculosis-endemic setting. We developed a transmission-dynamic mathematical model and calibrated it to data from two high-incidence communities of approximately 40 000 people in suburban Cape Town, South Africa. We used the model to estimate overall cost and disability-adjusted life-years (DALYs) associated with annual follow-up examinations and secondary isoniazid preventive therapy (IPT), alone and in combination, among individuals completing tuberculosis treatment. We investigated scenarios under which these interventions were restricted to the first year after treatment completion, or extended indefinitely. For each intervention scenario, we projected health system costs and DALYs averted with respect to the current status quo of tuberculosis control. All estimates represent mean values derived from 1000 epidemic trajectories simulated over a 10-year period (2019–28), with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values. We estimated that a single follow-up examination at the end of the first year after treatment completion combined with 12 months of secondary IPT would avert 2472 DALYs (95% UI −888 to 7801) over a 10-year period and is expected to be cost-saving compared with current control efforts. Sustained annual follow-up and continuous secondary IPT beyond the first year after treatment would avert an additional 1179 DALYs (−1769 to 4377) over 10 years at an expected additional cost of US$18·2 per DALY averted. Strategies of follow-up without secondary IPT were dominated (ie, expected to result in lower health impact at higher costs) by strategies that included secondary IPT. In this high-incidence setting, post-treatment follow-up and secondary preventive therapy can accelerate declines in tuberculosis incidence and potentially save resources for tuberculosis control. Empirical trials to assess the feasibility of these interventions in settings most severely affected by tuberculosis are needed.