A859 benefits were discounted at a fixed annual rate of 3%. Results: In base-case analysis, TST followed by QFT strategy was the most cost-effective among mental patients. No screening and CXR strategies were less cost-effective. Cost-effectiveness was sensitive to LTBI rate and BCG vaccination rate among non-smokers. No screening strategy was more cost-effective than TST followed by QFT strategy at the willingness to pay level of $US 100,000/QALY gained when LTBI rate among non-smokers was less than 0.10. The QFT strategy was more cost-effective than TST followed by QFT strategy at the willingness to pay level of $US 100,000/QALY gained when BCG vaccination rate among non-smokers was less than 0.18. ConClusions: TB screening using an IGRA for mental patients is recommended on the basis of the cost-effectiveness, especially with tobacco smoking. This suggests that further supporting tobacco cessation intervention for smoking mental patients is beneficial to control TB. PMD15 HealtH econoMic evaluation of WatcHMantM left atrial aPPenDage closure (laac) Device vesus long-terM Warfarin tHeraPy in Patients WitH atrial fibrillation (af) in cHina
Background : In contrast to tuberculous pleurisy, tuberculous empyema is a chronic active infectious disease of the pleural cavity that is frequently accompanied by cavitary or advanced pulmonary lesions. The condition requires long-term anti-tuberculous medication with external drainage. The clinical features and treatment outcome of tuberculous empyema are unclear despite the high prevalence of tuberculosis in Korea. Methods : From January 1991 through April 2004, 17 patients diagnosed with tuberculous empyema in Kyungpook National University Hospital were enrolled in this study. Their medical records and chest radiographs were reviewed. Results : Twelve patients(71%) had a history of tuberculosis and six of the 12 patients were under current anti-tuberculous medication. Productive cough, fever, and dyspnea were the main complaints. There was no predominance between the right and left lungs. Nine patients(53%) had far-advanced pulmonary tuberculosis, two(12%) had a cavitary lesion, and seven(41%) had a pyopneumothorax on the chest radiograph. All eight cases in whom the data of pleural fluid WBC differential count was available showed polymorphonuclear leukocyte predominance. Eight patients(47%) had other bacterial infections as well. The overall rates of a positive sputum AFB smear and culture for M. tuberculosis were 71% and 64%, respectively. The positive AFB smear and culture rates for M. tuberculosis from the pleural fluid were 33% and 36%, respectively. Twelve of the 16 patients(75%) were treated successfully. Three underwent additional surgical intervention. Two patients (12%) died during treatment. Conclusion : Tuberculous empyema is frequently accompanied by advanced pulmonary lesions, and polymorphonuclear leukocytes are predominant in the pleural fluid. Other accompanying bacterial infections in the pleural cavity are also common in tuberculous empyema patients. Therefore, tuberculous empyema should be considered in differential diagnosis of patients with polymorphonuclear leukocyte-predominant pleural effusion. In addition, more active effort will be needed to achieve a bacteriological diagnosis in the pleural fluid.
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