巴西曾被监禁者结核分枝杆菌感染筛查和治疗的成本效益和健康影响:马尔可夫模型研究。

IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Global Health Pub Date : 2024-09-01 DOI:10.1016/S2214-109X(24)00221-3
Ana van Lieshout Titan, Fayette Klaassen, Daniele Maria Pelissari, José Nildo de Barros Silva, Kleydson Alves, Layana Costa Alves, Mauro Sanchez, Patricia Bartholomay, Fernanda Dockhorn Costa Johansen, Julio Croda, Jason R Andrews, Marcia C Castro, Ted Cohen, Cornelis Vuik, Nicolas A Menzies
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引用次数: 0

摘要

背景:曾被监禁的人结核病发病率很高,但一般不被视为符合结核病预防条件的高危人群。我们调查了结核分枝杆菌感染筛查和结核病预防治疗(TPT)对巴西曾被监禁者的潜在健康影响和成本效益:我们利用巴西已公布的证据,构建了一个马尔可夫状态转换模型,通过模拟健康状态随时间的转换,估算了曾被监禁者中与结核病相关的健康结果和成本。该分析比较了结核病感染筛查和 TPT,以及不进行筛查,并考虑了 M 型结核病感染检测和 TPT 方案的组合。我们将健康效应量化为结核病病例、结核病死亡人数和残疾调整寿命年数(DALYs)的减少。我们从结核病计划的角度评估了成本。我们以每避免一个残疾调整生命年的增量成本来报告干预措施的成本效益,并测试了不同目标人群的结果有何变化:与不采取任何干预措施相比,采用结核菌素皮试和为期 3 个月的异烟肼和利福喷丁治疗的干预措施可避免每 1000 人中 31 例(95% 不确定区间为 14-56)终生结核病例和 4-1 例(1-4-5-8)终生结核病死亡病例,每避免 1 DALY 的成本为 242 美元。与不进行筛查相比,所有检测和治疗方案组合都具有成本效益。年龄越小、监禁时间越长、出狱时间越近,对健康的益处就越大,成本效益比率也越高,尽管对所有受检亚组而言,干预措施都具有成本效益:对曾被监禁的人进行M型结核感染筛查和TPT似乎具有成本效益,并能带来宝贵的健康收益:资金来源:美国国立卫生研究院:摘要的葡萄牙语译文见 "补充材料 "部分。
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Cost-effectiveness and health impact of screening and treatment of Mycobacterium tuberculosis infection among formerly incarcerated individuals in Brazil: a Markov modelling study.

Background: Individuals who were formerly incarcerated have high tuberculosis incidence, but are generally not considered among the risk groups eligible for tuberculosis prevention. We investigated the potential health impact and cost-effectiveness of Mycobacterium tuberculosis infection screening and tuberculosis preventive treatment (TPT) for individuals who were formerly incarcerated in Brazil.

Methods: Using published evidence for Brazil, we constructed a Markov state transition model estimating tuberculosis-related health outcomes and costs among individuals who were formerly incarcerated, by simulating transitions between health states over time. The analysis compared tuberculosis infection screening and TPT, to no screening, considering a combination of M tuberculosis infection tests and TPT regimens. We quantified health effects as reductions in tuberculosis cases, tuberculosis deaths, and disability-adjusted life-years (DALYs). We assessed costs from a tuberculosis programme perspective. We report intervention cost-effectiveness as the incremental costs per DALY averted, and tested how results changed across subgroups of the target population.

Findings: Compared with no intervention, an intervention incorporating tuberculin skin testing and treatment with 3 months of isoniazid and rifapentine would avert 31 (95% uncertainty interval 14-56) lifetime tuberculosis cases and 4·1 (1·4-5·8) lifetime tuberculosis deaths per 1000 individuals, and cost US$242 per DALY averted. All test and regimen combinations were cost-effective compared with no screening. Younger age, longer incarceration, and more recent prison release were each associated with significantly greater health benefits and more favourable cost-effectiveness ratios, although the intervention was cost-effective for all subgroups examined.

Interpretation: M tuberculosis infection screening and TPT for individuals who were formerly incarcerated appears cost-effective, and would provide valuable health gains.

Funding: National Institutes of Health.

Translation: For the Portuguese translation of the abstract see Supplementary Materials section.

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来源期刊
Lancet Global Health
Lancet Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
44.10
自引率
1.20%
发文量
763
审稿时长
10 weeks
期刊介绍: The Lancet Global Health is an online publication that releases monthly open access (subscription-free) issues.Each issue includes original research, commentary, and correspondence.In addition to this, the publication also provides regular blog posts. The main focus of The Lancet Global Health is on disadvantaged populations, which can include both entire economic regions and marginalized groups within prosperous nations.The publication prefers to cover topics related to reproductive, maternal, neonatal, child, and adolescent health; infectious diseases (including neglected tropical diseases); non-communicable diseases; mental health; the global health workforce; health systems; surgery; and health policy.
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