γ-干扰素释放试验筛查潜伏性结核患者的成本效果分析

Interferon-γ Release Assays Screening for Latent Tuberculosis Screening:A Cost-Effectiveness Analysis

目的利用模型假设对结核密切接触者分别实施:结核菌素试验(TST试验)或T.SPOT试验单用(即单用)和TST阳性者追加使用T.SPOT试验策略(即联用),分析不同筛查策略的成本效果,为我国推广利用T.SPOT试验筛查潜伏性结核提供经济学依据。方法假设1000名结核密切接触者分别接受上述3种筛查策略。使用TreeAge Pro 2004软件构建决策树模型并设定模型假设条件。模型时间假设为1年。选取预防1例活动性结核所需的增量成本为结局指标并进行单因素敏感性分析。收集官方数据和已发表文献数据并进行Meta分析确定率值参数。成本数据来源首选各省官方数据,其余数据联系医院获取。结果①T.SPOT试验总成本最高(212213.81元/千人),TST试验次之,TST与T.SPOT联用总成本成本最低;②预防1例活动性结核需要筛查的潜伏性结核患者人数,TST试验最多,达25.67例;TST与S.SPOT联用最少,仅8.31例。③预防1例活动性结核,TST与T.SPOT联用所致的增量成本最小,为3063.50元,T.SPOT试验次之,TST试验最高;④在其他参数不变情况下,患病率达到60%或TST试验灵敏度或特异度分别达到70%以上时,TST单用成本效果优于T.SPOT单用。结论 T.SPOT单用可提高预防活动性结核的例数,T-SPOT与TST联用较二者成本效果更好。患病率、TST试验效果指标会影响成本效果,但联用成本效果始终最高。

Objective To evaluate the cost-effectiveness of three LTBI screening strategies： the tuberculin skin test（TST）,the T-SPOT.TB and the combination of TST and T-SPOT（TST＋T.SPOT）,to provide economic evidence for T.SPOT application in China.Methods A decision analysis model evaluated three strategies among a cohort of 1000 tuberculosis（TB） close contacts,using incremental cost-effectiveness of prevention a active TB patient（1 year post contact）.Meta analyses were conducted to calculate the key parameters of T.SPOT and TST.The official data or literature was searched and the unaccessible data was to specify other parameters,such as cost,LTBI prevalence,etc.The one-way sensitivity analysis was performed,varying key parameters over a wide range of reasonable values to evaluate the impact of data uncertainties and to determine the robustness of our overall conclusion.Results a） As for the total cost,the TST＋T.SPOT strategy（$212 213.81 per 1 000 contacts） cost the least,while the single T.SPOT strategy cost the most;b） Subsequently,the TST＋T.SPOT strategy required less contacts to be treated to prevent an active case of TB（8.31） than the single TST strategy（25.67）;c） the TST＋T.SPOT strategy shared the most cost-effectiveness（$3 063.50 per active TB case prevented） than the single TST or T.SPOT strategy;and d） The results of one-way sensitivity analyses showed that cost-effectiveness values were sensitive to changes in LTBI prevalence（60%）,Sen and Spn of TST test（70%）,with the single TST being superior to the single T.SPOT.Conclusion The Single T.SPOT strategy enjoys the most cases prevented from active TB,while the TST＋S.SPOT strategy is the most cost-effective.The conclusion is sensitive to a few parameters,such as LTBI prevalence,but the TST＋T.SPOT strategy is always the best.