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在高负担环境中扩大对耐药结核病的诊断测试:成本效益分析
Marya Getchell1, John Pastor Ansah2, Dodge Lim3
1Duke-NUS Medical School, Program in Health Services and Systems Research, Singapore, Singapore. maya.getchell@gmail.com.
BMC public health
|November 5, 2025
概括
基因Xpert XDR是一种具有成本效益的工具,用于在高负担国家检测耐药结核病 (DR-TB). 目标下一代测序 (tNGS) 在常规使用中成本效益较低,但可能有利于高风险群体.
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:
- 关于GeneXpert XDR和针对性下一代测序 (tNGS) 等新型诊断的实施和成本效益的数据有限,用于在高结核病负担,低资源环境中检测耐药结核病 (DR-TB).
- 评估这些工具对于优化资源有限的环境中的结核病控制策略至关重要.
研究的目的:
- 确定使用GeneXpert XDR或tNGS用于DR-TB检测的不同策略的成本效益.
- 为了比较这些策略在高结核病负担,低资源设置,特别是菲律宾和泰国.
主要方法:
- 使用世界卫生组织 (WHO) 来自菲律宾和泰国的结核病数据开发和校准了一个动态模拟模型.
- 扩大药物耐药性诊断测试的干预场景从2025年到2035年进行模拟.
- 从卫生系统的角度评估了成本效益,利用国家特定的结核病诊断和治疗成本,并通过残疾调整寿命年 (DALYs) 估计健康益处.
主要成果:
- 无论是GeneXpert XDR还是tNGS的实施都改善了结核病健康结果.
- 与tNGS策略相比,GeneXpert XDR策略的成本效益更高.
- 用GeneXpert XDR测试所有结核病例在两国都被发现具有成本效益,成本效益较低,但对于以前治疗的病例仍然可行.
- 只有在更高的支付意愿值时,tNGS才被认为具有成本效益.
结论:
- 在高结核病负担的国家,GeneXpert XDR是对DR-TB诊断测试的经济有效补充.
- 目前,tNGS在常规DR-TB临床测试中成本效益低下,但对特定高风险人群和新的结核病治疗方案具有潜力.
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