河南省涂阳肺结核病人筛检成本效果分析

COST-EFFECTIVENESS ANALYSIS ON SCREENING FOR SMEAR-POSITIVE PULMONARY TUBERCULOSIS CASES

目的 :探讨成本效果好、发现效率高的涂阳肺结核病人筛检方案。方法 :采用整群随机抽样的方法在河南全省抽取 4 6个调查点 ,将调查点 15岁以上人口作为筛检人群 ;首先进行症状筛检 ,然后胸透 ,最后采用痰涂片检查确诊 ;根据症状筛检指标 ,设计 5种筛检方案。进行筛检成本效果分析。结果 :成本效果比较低的前 5位筛检为 A筛检 15～岁年龄组 (2 5 .0元 /例 )、≥ 75岁组 (5 5 .0元 /例 )、 6 0～岁组 (131.7元 /例 )、 B筛检≥ 75岁组 (16 7.8元 /例 )、 C筛检≥ 75岁组(16 7.8元 /例 ) ;人群涂阳肺结核病人检出率较高的前 5位筛检为 E、B、 C、 D筛检≥ 75岁年龄组人群 ,E筛检 6 0～岁年龄组人群 ,分别为 716 .2 / 10 5、 5 85 .9/ 10 5、 5 85 .9/ 10 5、 5 85 .9/ 10 5、 4 0 0 .2 / 10 5。结论 :C或 B筛检方案筛检≥ 75岁年龄组人群检出率、发现率、成本效果都较好 。

Objective:To study the cost-effective and efficient screening strategy for smear positive pulmonary tuberculosis (TB) cases.Methods:The people aged 15 and older were regarded as screening objects in 46 survey clusters selected with delamination and cluster random sample; the screening means was symptom,fluoroscopy and sputum smear in turn; according to the symptoms,five strategies were designed,A:cough and expectoration more than 3 weeks and emptysis,B:cough and expectoration more than 3 weeks,C:cough and expectoration more than 3 weeks or emptysis,D:cough,expectoration or emptysis;E:all screening objects were examined with fluoroscopy without symptom screening.Results:The first five cost-effective screening strategies were A screening ≥15 and <30 years old people (25.0yuan/case),A screening≥75 years old people(55.0yuan/case),A screening≥60 and <75 years old people(131.7yuan/case),B screening ≥75 years old people(167.8yuan/case),C screening ≥75 years old people(167.8yuan/case);the first five high smear-positive-pulmonary-TB detected rate screening strategies were E,B,C or D screening ≥75 years old people and E screening≥60 and <75 years old people,which were 716.2/10 5?585.9/10 5?585.9/10 5?585.9/10 5?400.2/10 5 respectively.Conclusion:The strategy of C or B screening ≥75 years old people was better one than the others.