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低复杂性查测试在社区结核病病例调查中的成本效益

Lukas E Brümmer^1,2,3, Ryan R Thompson³, Akash Malhotra³

¹Division of Infectious Disease and Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

|August 25, 2023

概括

低复杂性结核病 (TB) 查测试可以提高社区病例发现的成本效益. 然而,这些测试必须是灵敏的,具体的,廉价的,以最大限度地提高结核病控制的效益.

科学领域:

公共卫生公共卫生
传染病流行病学传染病流行病学
卫生经济学卫生经济学

背景情况:

结核病 (TB) 仍然是一个重大的全球卫生挑战,特别是在高负担地区.
基于社区的病例调查对结核病控制至关重要,但其成本效益可能有限.
低复杂性查测试在扩大结核病例发现中的作用和经济影响尚不清楚.

研究的目的:

评估不同基于社区的结核病例发现策略的成本效益.
为了比较通用唾液Xpert超级测试与结合点治疗C反应蛋白 (CRP) 或新型假设查测试的策略.

主要方法:

开发了一个微模拟模型来评估三种结核病病例发现方法.
该模型模拟了印度,南非,菲律宾,乌干达和越南的假设人口,结核病患病率是国家估计的四倍.
费用包括直接的医疗费用和治疗费用,以2023美元表示.

主要成果:

据估计,万能Xpert超级测试每10万人进行查,每人花费400万美元,避免3200个残疾调整寿命年 (DALY).
预计C-反应蛋白 (CRP) 查将更具成本效益,每DALY避免 (550-1500美元),但避免了44%的DALYs.
一个假设的查测试,如果优化高灵敏度 (95%) 和特异性 (95%) 以低成本 ($4.5),可以实现每天390-940美元的成本效益.

结论:

查测试可以提高社区结核病例发现的成本效益.
查测试的有效性取决于其敏感性,特异性和成本.
优化查策略有可能改善资源有限的环境中的结核病控制工作.

关键词:

经济效益性经济效益性诊断诊断诊断诊断诊断数学模型的数学建模.查检查查检查查检查查检查结核病是一种肺结核病.

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