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用转录签名查美国移民初始结核病的成本效益

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

¹Interfaculty Initiatives in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America.

|May 8, 2025

概括

主体响应转录特征 (HrTS) 显示了在美国移民中查初始结核病 (TB) 的潜在成本效益. 对高发病率国家而言,仅使用干扰素释量测试 (IGRA) 的策略是最佳的,而对于中等发病率国家,IGRA-HrTS可能具有成本效益.

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:

基于宿主反应的转录签名 (HrTS) 是识别"结核病 (TB) "的新兴工具.
在低发病率国家的移民抵达后查中缺乏HRTS的成本效益数据.
这项研究评估了HRTS对美国新移民结核病查的健康影响和成本效益.

研究的目的:

为了评估不同查策略的成本效益结核病 (TB) 在新抵达的移民在美国.
为了比较包括没有查,干扰素释试验 (IGRA) 单独,IGRA 随后 HrTS 和 HrTS 单独的策略.
根据健康影响 (获得的质量调整寿命) 和成本,确定最佳策略.

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.
在2019年进入美国的移民一生中评估了结果.
进行了敏感性分析,以评估研究结果的可靠性,考虑到不同支付意愿门和原产国结核病发病率.

主要成果:

只有IGRA的策略在15万美元/QALY的支付意愿值是最佳的,ICER为104,138美元 (医疗保健) 和143,103美元 (社会).
在100,000美元/QALY值下,IGRA-HrTS策略似乎是最佳的.
策略的有效性因原产国结核病发病率而异:仅对发病率≥100/100,000的IGRA,对<10/100,000没有查,对10-100/100,000的IGRA-HrTS可能具有成本效益.

结论:

符合最佳标准的宿主响应转录签名 (HrTS) 显示了选美国移民子集的潜在成本效益.
最佳策略对包括支付意愿,原产国结核病发病率和结核病进展风险在内的因素敏感.
需要进一步的研究来验证这些发现,并解决成本效益的不确定性.

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