不同耐药结核病检测技术的防控效果和成本效用研究

Study on the prevention and control efficacy and cost-effectiveness of different detection technologies for drug-resistant tuberculosis

目的:评估耐药结核的不同检测技术的效果与成本效用。方法:根据耐药结核的发病和传播特征,构建决策树-马尔可夫模型,评估使用固体培养+药物敏感试验、Xpert检测、液体培养+药物敏感试验以及全基因组测序技术进行检测下耐药结核在20年内的发病人数、死亡人数、总医疗成本和健康效益(以质量调整生命年,QALY,来衡量),并进行成本效用分析。结果:与采用固体培养+药物敏感试验的方式相比,Xpert检测表现最佳。在研究周期内,Xpert检测模拟情景下每月平均发病人数、复发人数和死亡人数均低于其他检测技术。此外,成本效用分析显示,与固体培养+药物敏感试验相比,其他3种检测技术均表现出成本效用优势:Xpert检测的增量成本效用比(ICUR)为-2598.89元/质量调整寿命年(QALY),液体培养后药物敏感试验的ICUR为-2476.66元/QALY,全基因组测序(WGS)的ICUR为-2429.46元/QALY。结论:相对于采用固体培养+药物敏感试验的方式,采用Xpert检测、液体培养+药敏试验和全基因组测序技术来检测耐药结核均可以降低耐药结核的发病人数、死亡人数和复发人数,并提高健康效用。其中,Xpert检测具有最佳的成本效用。

Objective:To assess the efficacy and cost-effectiveness of different diagnostic technologies for drug-resistant tuberculosis.Methods:Based on the incidence and transmission characteristics of drug-resistant tuberculosis,a decision tree-Markov model was constructed to evaluate the number of incident cases,deaths,total medical costs,and health benefits(measured in quality-adjusted life years,QALYs)of drug-resistant tuberculosis over a 20-year period using different detection methods,including solid culture with drug susceptibility testing,Xpert testing,liquid culture with drug susceptibility(LCDS)testing,and whole-genome sequencing(WGS)technology.Cost-effectiveness analysis was also conducted.Results:Compared to the solid culture and drug susceptibility testing approach,Xpert demonstrated the best performance,with lower numbers of monthly average incident cases,relapse cases,and death during the cycle.Cost-effectiveness analysis showed that,compared to solid culture followed by drug susceptibility testing,the other three diagnostic technologies were all cost-effective.The incremental cost-effectiveness ratio(ICUR)for Xpert testing was-2598.89 CNY/QALY,for LCDS testing,it was-2476.66 CNY/QALY,and for WGS,it was-2429.46 CNY/QALY.Conclusion:Compared to the solid culture and drug susceptibility testing approach,Xpert testing,LCDS testing and WGS testing reduced the number of incident cases and deaths,increased QALYs,and were all cost-effective,with Xpert testing being the most cost-effective among them.