对泰国肺结核患者的诊断测试的经济评估:一种动态传播模型的方法
Natthakan Chitpim1, Naiyana Praditsitthikorn2, Lisa J White3
1Social, Economic and Administrative Pharmacy (SEAP) Graduate Program, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
PloS one
|March 3, 2025
概括
在泰国,Xpert MTB/RIF是一种节省成本的结核病 (TB) 诊断初始测试. 像TB-LAMP这样的较新的分子测试也是成本效益高的结核病检测的附加或初始策略.
科学领域:
- 卫生经济学 卫生经济学
- 传染病诊断 传染病诊断 传染病诊断
- 公共卫生政策 公共卫生政策
背景情况:
- 传统的结核病 (TB) 诊断在泰国是缓慢的,而像Xpert MTB/RIF和TB-LAMP这样的分子分析提供更快的结果,但成本更高.
- 评估不同结核病诊断算法的成本效益对于优化医疗保健资源配置至关重要.
研究的目的:
- 从泰国的社会角度评估5种结核病诊断算法的成本效益.
- 将分子诊断测试 (Xpert MTB/RIF,TB-LAMP) 作为初始或附加策略与标准唾液涂抹显微镜 (SSM) 与培养和药物敏感性测试 (DST) 进行比较.
主要方法:
- 一个动态传播模型模拟了15年的结核病诊断.
- 成本计算为2023泰,结果呈现为每QALY获得的增量成本效益比率 (ICER).
- 进行了灵敏度分析,以评估参数不确定性.
主要成果:
- 作为初步测试,Xpert MTB/RIF被发现与具有培养和DST的SSM相比具有成本节约性.
- TB-LAMP 附加功能 (3,563 巴特/QALY),Xpert MTB/RIF 附加功能 (3,670 巴特/QALY) 和 TB-LAMP 初始功能 (6,429 巴特/QALY) 是具有成本效益的.
- 处理效用和Xpert MTB/RIF单元成本在敏感性分析中显著影响了ICER.
结论:
- 建议Xpert MTB/RIF作为一般泰国人口的初始诊断测试.
- 研究结果支持将分子检测纳入泰国的全民覆盖计划,以减少结核病发病率和死亡率.
- 政策建议与结核病控制的国家战略保持一致.
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