Cost-effectiveness analysis of tuberculosis detection strategy based on close contact cohort

Abstract

Background Close contacts of active pulmonary tuberculosis patients are high-risk groups for tuberculosis. Through active screening of contacts, more contacts who have recently been exposed to pulmonary tuberculosis patients, early existing pulmonary tuberculosis patients, and latent infections can be found. Methods The decision tree Markov model of close contacts screening strategy was established to simulate the cohort of close contacts of tuberculosis. The cost effects of passive screening strategy and active screening once, twice, and once a year were compared. Single-factor and probability sensitivity analyses were conducted to test the impact of assumptions and parameter estimates in the model on cost-effectiveness analysis. Results Compared with passive screening, active screening once, twice, and once a year could reduce the incidence of latent infection by 0.21%, 14.286%, and 63.48%, respectively; Compared with the passive screening strategy, active screening once, twice, and once a year can reduce the incidence of active tuberculosis by 4.13%, 11.22%, and 50.04% respectively; Compared with the passive screening strategy, the active screening once, twice and once a year strategy reduced the incidence of TB deaths by 2.86%, 5.71%, and 11.43% respectively. Compared with the passive screening strategy, active screening once, active screening twice, and active screening once a year will cost 8800.43 RMB, 5781.70 RMB, and 13825.04 RMB more for each additional QALY, which is lower than the willingness of Chinese people to pay and is less than twice the GDP of Xinjiang. The increased cost of obtaining an additional QALY is entirely worth it. All these are advantageous strategies. Conclusion Compared with the passive screening strategy, the cost and effect of the active screening strategy of once, twice, and once a year increase in turn, which can reduce the incidence of LTBI, tuberculosis, and tuberculosis death, and are all advantageous strategies. Continuous active screening of tuberculosis in critical populations is one of the key measures to quickly reduce the epidemic situation of tuberculosis. It is recommended to carry out regular screening for all close contacts of active tuberculosis patients. Reasonably allocate health resources, and propose reasonable screening methods for different age groups and critical groups.