Tuberculosis Control Priorities Defined by Using Cost-Effectiveness and Burden of Disease

Objective To define TB control priorities using cost-effectiveness and burden of disease.Methods An assumed cohort of 2 000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in1994.Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters.Results DOTS reduced 89.19% of YLL,78.90% of YLD,and 99.98% of infectivity BOD.One DALY could be saved with 45.70% Yuan by DOTS with 3% discount.Sensitivity analysis showed that discount had effect on CER.Weight of age was insensitive to CER.The higher the DOTS coured rate,the more the cost-effectiveness.Conclusions DOTS is a good cost-effectiveness TB control strategy.Cost-effectiveness and burden of disease can be used to define TB control priorities.

初治涂阳肺结核病人DOTS及非DOTS干预的成本-效果分析

目的 评价初治涂阳肺结核病人DOTS及非DOTS干预的成本 -效果。方法 以初治涂阳肺结核病人用于药品、痰涂片、痰培养及X线检查四个部分的支出构成成本 ;干预的效果包括直接与间接效果两部分 :一是治愈病人而减少的DALY损失 ,二是降低传染而减少的DALY损失。结果 DOTS干预的病人以 4 5 7元即可挽救一个寿命年 ,而非DOTS干预的病人则需要 4 71 .3元才能挽救一个寿命年。结论 DOTS是费用 -效果佳的结核病控制策略。

NRAMP1基因3′UTR多态性位点与白族肺结核易感相关性研究

目的:探讨NRAMP1基因3'UTR位点多态性与大理白族肺结核病易感相关性及抗结核疗效的联系。方法:采用PCRRFLP方法检测193例白族肺结核病人及191例白族健康人群的NRAMP1基因3′UTR位点的基因型,分析其与白族人群患肺结核病的易感相关性,且对病人进行抗结核治疗1月后随访及不良反应观察,分析NRAMP1基因多态性与病人抗结核疗效的关系。结果:NRAMP1基因3′UTR位点GA、AA基因型均为白族患者肺结核的发病风险因子(OR=2.208和3.373,95%CI=[1.343-3.630]和[1.114-10.210])。A等位基因与白族人群肺结核病发病呈明显正相关(OR=2.219,95%CI=[1.470-3.349])。抗结核治疗后各基因型发生不良反应的类型及程度差异均无统计学意义(P>0.05)。结论:NRAMP1基因3′UTR多态性可能与大理白族人群肺结核的易感性相关。患者抗结核治疗后发生的不良反应情况与NRAMP1基因3′UTR位点多态性无相关性。