用转录签名查美国移民初始结核病的成本效益

用转录签名查美国移民初始结核病的成本效益

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Yuli Lily Hsieh^1,2, C Robert Horsburgh³, Ted Cohen⁴

¹Interfaculty Initiatives in Health Policy, Harvard University, Cambridge, USA.

medRxiv : the preprint server for health sciences

|October 17, 2024

概括

基于宿主反应的转录签名 (HrTS) 在新抵达美国的移民中对初始结核病 (TB) 的查不具有成本效益. 只有IGRA的策略被证明是优越的,与基于HRTS的方法相比,它提供了更好的健康结果和价值.

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:

基于宿主反应的转录特征 (HrTS) 对识别初始结核病 (TB) 是有前途的.
在低发病率国家的移民入境后查计划中,HRTS的成本效益仍然没有研究.
结核病 (TB) 仍然是一个全球性的健康问题,需要为移民人口制定有效的查策略.

研究的目的:

评估HRTS对美国新移民的健康影响和成本效益,用于抵达后的结核病感染查.
将基于HRTS的查策略与当前的标准实践进行比较.

主要方法:

使用离散事件模拟模型来比较四种结核病查策略.
策略包括没有查,干扰素释测试 (IGRA) 仅,IGRA 随后 HrTS,以及 HrTS 仅.
在2019年进入美国的移民一生中评估了结果,并进行了敏感性分析.

主要成果:

从医疗保健和社会角度来看,只有IGRA的战略主导了基于HRTS的战略.
仅IGRA的增量成本效益比为78,943/QALY (医疗保健) 和89,431/QALY (社会).
结果对HRTS成本和支付意愿值的变化很强大,但对结核病进展风险下降很敏感.

结论:

即使符合最佳目标产品简介标准的HRTS,在抵达美国后对移民进行结核病查也不太可能具有成本效益.
只有IGRA的策略代表了这个人群的更具成本效益的方法.
可能需要进一步的研究,以优化结核病查策略的移民健康.

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