Opportunities for tuberculosis elimination in the Canadian Arctic: cost-effectiveness of community-wide screening in a remote Arctic community

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Americas Pub Date : 2024-10-30 DOI:10.1016/j.lana.2024.100916
{"title":"Opportunities for tuberculosis elimination in the Canadian Arctic: cost-effectiveness of community-wide screening in a remote Arctic community","authors":"","doi":"10.1016/j.lana.2024.100916","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>In response to a tuberculosis (TB) outbreak in the remote community of Qikiqtarjuaq Nunavut, Canada, community leaders and the territorial government initiated community-wide screening (CWS) for tuberculosis, an expensive undertaking given the high cost of providing medical services in the Canadian arctic. Our study aim was to assess the cost-effectiveness of the Qikiqtarjuaq CWS.</div></div><div><h3>Methods</h3><div>We developed a hybrid decision analysis and Markov model to replicate the experience and extrapolate CWS outcomes over a 20-year time horizon. Following a hypothetical cohort with patient characteristics reflecting the demographic and testing data available from the CWS, the model compared a one-time CWS intervention with the reference case of ‘no community-wide screening’.</div></div><div><h3>Findings</h3><div>CWS resulted in improved health gains through prevention of active tuberculosis cases compared with no CWS. It also resulted in increased costs (measured in Canadian dollars), with a very low estimated incremental cost-effectiveness ratio (ICER) of $25.10 (95% URs: cost savings-$15,874) per additional quality adjusted life year (QALY) gained compared with current standard of care approach (no CWS). Community-wide screening in this context would be considered highly cost-effective in this setting. In probabilistic sensitivity analysis, we found &gt;99% of iterations were cost-effective at a willingness to pay threshold of $50,000/QALY gained.</div></div><div><h3>Interpretation</h3><div>While costly, coordinated and intensive community-wide tuberculosis screening activities are highly cost-effective in remote arctic communities when utilized in an outbreak context.</div></div><div><h3>Funding</h3><div>Government of Nunavut.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":null,"pages":null},"PeriodicalIF":7.0000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Regional Health-Americas","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2667193X24002436","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

Background

In response to a tuberculosis (TB) outbreak in the remote community of Qikiqtarjuaq Nunavut, Canada, community leaders and the territorial government initiated community-wide screening (CWS) for tuberculosis, an expensive undertaking given the high cost of providing medical services in the Canadian arctic. Our study aim was to assess the cost-effectiveness of the Qikiqtarjuaq CWS.

Methods

We developed a hybrid decision analysis and Markov model to replicate the experience and extrapolate CWS outcomes over a 20-year time horizon. Following a hypothetical cohort with patient characteristics reflecting the demographic and testing data available from the CWS, the model compared a one-time CWS intervention with the reference case of ‘no community-wide screening’.

Findings

CWS resulted in improved health gains through prevention of active tuberculosis cases compared with no CWS. It also resulted in increased costs (measured in Canadian dollars), with a very low estimated incremental cost-effectiveness ratio (ICER) of $25.10 (95% URs: cost savings-$15,874) per additional quality adjusted life year (QALY) gained compared with current standard of care approach (no CWS). Community-wide screening in this context would be considered highly cost-effective in this setting. In probabilistic sensitivity analysis, we found >99% of iterations were cost-effective at a willingness to pay threshold of $50,000/QALY gained.

Interpretation

While costly, coordinated and intensive community-wide tuberculosis screening activities are highly cost-effective in remote arctic communities when utilized in an outbreak context.

Funding

Government of Nunavut.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
加拿大北极地区消除结核病的机遇:在北极偏远社区开展全社区筛查的成本效益
背景针对加拿大努纳武特地区偏远社区 Qikiqtarjuaq 爆发的结核病(TB)疫情,社区领导和地区政府启动了全社区结核病筛查(CWS),由于在加拿大北极地区提供医疗服务的成本高昂,这项工作耗资巨大。我们的研究目的是评估 Qikiqtarjuaq CWS 的成本效益。方法我们开发了一个混合决策分析和马尔可夫模型,以复制经验并推断 20 年时间范围内的 CWS 结果。该模型以一个假定的队列为基础,患者特征反映了 CWS 所提供的人口统计和检测数据,并将一次性 CWS 干预与 "无社区范围筛查 "的参考情况进行了比较。与目前的标准护理方法(不进行社区卫生服务)相比,该方法也增加了成本(以加元计算),估计增量成本效益比为 25.10 加元(95% URs:节约成本-15,874 加元)。在这种情况下,全社区筛查被认为具有很高的成本效益。在概率敏感性分析中,我们发现在 50,000 美元/QALY 收益的支付意愿阈值下,99% 的迭代具有成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
8.00
自引率
0.00%
发文量
0
期刊介绍: The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.
期刊最新文献
HIVR4P conference 2024 Leticia de Oliveira — a voice against gender-biased research opportunities Brazil's tax exemption on ultra-processed foods: a public health setback Opportunities for tuberculosis elimination in the Canadian Arctic: cost-effectiveness of community-wide screening in a remote Arctic community Active shooters and gun-free zones: emotional versus legal motivations – author's reply
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1