经济较发达农村地区结核病慢性咳嗽线索筛查的成本效果研究

A cost-effectiveness study on a case-finding program of tuberculosis through screening those suspects with chronic cough symptoms in the rich rural areas

目的研究在经济较发达农村地区实施以社区线索筛查为基础主动发现结核病模式的可行性及其成本效果。方法对浙江省北部结核病控制项目(CIDA)县德清县抽取3个各1万人口以上的乡镇,每3个月一次进行连续三次慢性咳嗽患者入户筛查,对筛查阳性者(慢咳疑似者)进行进一步X线和痰检诊断。结果共筛查86618人次,发现结核病患者26例,其中涂阳病例7例;首次筛检效果优于随后的二次筛查;三次筛查每发现一例患者的费用分别为631、2397和1637元;在总筛查成本中,5．9％由结核病患者自负,35．9％由当地县财政负担。结论以社区线索筛查为基础发现结核病的筛查方式,有可能筛查出较多数量的潜在结核病例。在6个月内,随着筛查次数的增加,患者检出率降低,在既往发现工作较差的地区,能取得较高的检出率。该项筛查适合在经济较发达、结核病防治基础较差的农村地区有组织地开展。

Objective To study the feasibility and cost-effectiveness of a case-finding program on tuberculosis （TB） in richer rural areas. Methods Screening was implemented every three months for a total period of 9 months, in rural areas with high case notification rates, Three villages, each with ten thousand population,were selected to carry out a household screening program. A suspect was defined as who coughed for more than 3 weeks. The suspect was then referred to further diagnosis in county TB dispensary to undergo chest X-ray and sputum test. Results Of the 86 168 community population screened,26 TB patients were identified with 7 of them were smear positive. The ratio of effectiveness vs. cost decreased on the second but slightly increased on the third screening program, The direct costs for the 3 screening programs were 631,2397 and 1637 RMB respectively. Of total direct cost, 5.9 % was paid by TB patients, whereas 35.9% was through financing of the county itself. Conclusion The community household screening program could achieve higher case detection rate than passive case-finding approach which could be used in richer areas with low case detection rate in China.