结核病成本效益分析的更广泛视角:多国研究中,患者产生的成本和结核病后的结果如何重塑估计值
Ewan M Tomeny1, Phuong Bich Tran2, Joseph Kazibwe3
1Centre for Tuberculosis Research, Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
PLOS global public health
|September 11, 2025
概括
了解结核病 (TB) 的全部成本对于有效的预防战略至关重要. 包括长期治疗后效应显著改善了结核病干预措施的成本效益估计,特别是在低收入国家.
科学领域:
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
- 流行病学 流行病学
背景情况:
- 结核病 (TB) 对全球健康和经济构成重大负担.
- 结核病干预措施的成本效益分析 (CEA) 对分析选择 (包括时间框架和前景) 非常敏感.
- 患者产生的成本和治疗后的长期影响往往不充分纳入CEA.
研究的目的:
- 评估不同的时间框架和成本前景如何影响结核病干预措施的估计成本效益.
- 具体评估包括治疗后效应和患者成本对预防性结核病干预的成本效益的影响.
- 通过强调由于狭的分析方法低估结核病干预措施的好处的风险,为政策决策提供信息.
主要方法:
- 利用了来自19个世卫组织结核病患者成本调查和全球流行病学数据库的数据.
- 建模了一个假设的预防性结核病干预,生成每个国家的四个增量成本效益比率 (ICER).
- 使用常规与延长时间框架 (包括结核病后影响) 的比较分析以及排除与包括患者成本的观点.
- 将主要分析固定在1×人均GDP的门上,以进行简化跨国比较.
主要成果:
- 除了结核病后效应或患者费用外,ICER增加了;当两者都省略时,ICER的最高值发生了.
- 在所有国家,结核病后的考虑对成本效益的影响远大于患者成本.
- 平均而言,不包括TB后期,ICER增加了50%以上.
- 包括患者支付的费用提高了预防的成本效益,特别是在低GDP环境中,但在2×GDP以上的影响很小.
结论:
- 对结核病干预措施的CEA范围的狭定义可能会低估干预效益.
- 纳入长期治疗后效应对于准确评估结核病干预措施的成本效益至关重要.
- 如果不考虑结核病的全部社会经济负担,特别是较低GDP国家的结核病预防政策决策可能会被误导.
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