Japan’s national tuberculosis control strategies with economic considerations

Ghotbi, Nader; Nishimura, Shuzo; Takatsuka, Naoyoshi

doi:10.1007/bf02897713

Cited by 6 publications

(12 citation statements)

References 16 publications

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“…Comparing younger adults, increased risks of TB transmission were reported in the elderly due to longer delay of diagnosis and treatment [ 6 , 13 , 19 , 20 , 22 , 24 , 26 – 28 ], in institutionalized older people and healthcare workers [ 6 , 13 , 19 – 24 , 26 – 28 ], and aged immigrants from a high-prevalence country [ 13 , 19 , 24 , 26 , 28 , 29 ]. Targeted interventions were suggested to obtain an early identification and containment as soon as possible to avoid postponement of therapy and silent spread of TB infection [ 13 , 19 – 21 , 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…Patient-initiated pathway, also called passive case-finding strategy, is basically adopted in most countries according to DOTS (directly observed treatment, short-course) strategy. Increasing patient access to care, reducing time to treatment by using new diagnostics and/or streamlining the diagnostic pathway are essential interventions to optimize current strategy [ 15 , 19 , 25 , 29 – 32 ]. Systematic screening pathway comprises screening for latent TB infection (LTBI) [ 6 , 13 , 15 , 19 – 32 ] and screening for TB patients [ 15 , 20 , 21 , 27 , 29 – 31 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

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The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Chung

Leung

et al. 2017

Infect Dis Poverty

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With the rapid pace of population ageing, tuberculosis (TB) in the elderly increasingly becomes a public health challenge. Despite the increasing burden and high risks for TB in the elderly, targeted strategy has not been well understood and evaluated. We undertook a scoping review to identify current TB strategies, research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets. Databases of Embase, MEDLINE, Global health and EBM reviews were searched for original studies, review articles, and policy papers published in English between January 1990 and December 2015. Articles examining TB strategy, program, guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria. Most of them were qualitative studies, issued in high- and middle-income countries and after 2000. To break the chain of TB transmission and reactivation in the elderly, infection control, interventions of avoiding delay in diagnosis and containment are essential for preventing transmission, especially in elderly institutions and aged immigrants; screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people; optimizing early case-finding with a high index of suspicion, systematic screening for prioritized high-risk groups, initial empirical and adequate follow-up treatment with close monitoring and evaluation, as well as enhanced programmatic management are fundamental pillars for active TB elimination. Evaluation of TB epidemiology, risk factors, impacts and cost-effectiveness of interventions, adopting accurate and rapid diagnostic tools, shorter and less toxic preventive therapy, are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway. The framework and principals identified in this study will help to evaluate and improve current program, develop targeted strategy, as well as raise more discussions on the research priority settings and policy transitions. Given the scarceness of policy and evaluated interventions, as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries, the increasing need of a ready TB program for the elderly warrants further research.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0284-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Chung

Leung

et al. 2017

Infect Dis Poverty

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“…Poor adherence of a patient is one of the reasons that TB develops to MDR‐TB; therefore, in 1995, the World Health Organization proposed directly observed treatment, short‐course to improve the success rate of TB treatment. In Japan, the dissemination and awareness of directly observed treatment, short‐course strategy is required …”

Section: Discussionmentioning

confidence: 99%

“…In Japan, the dissemination and awareness of directly observed treatment, short-course strategy is required. 23 Except in patients with concomitant PTB, it is not essential for EPTB patients to be hospitalized in specialized institutions. 4 In the present study, 35 UTB patients were referred to such institutions.…”

Section: Discussionmentioning

confidence: 99%

Nationwide survey of urogenital tuberculosis in Japan

et al. 2014

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Objectives: To determine current epidemiology and treatment patterns of urogenital tuberculosis in Japan. Methods: A questionnaire was sent to the urological departments of 1203 Japanese hospitals. Clinical data was reviewed retrospectively; no time range was specified. Results: Of the 1203 hospitals, 399 returned questionnaires with information about 355 urogenital tuberculosis patients. Of the 399, 153 institutions reported at least one patient, and 201 patients were identified between 2000 and 2007. Infections were located in the kidneys (n = 242), ureter (n = 96), bladder (n = 100), epididymis or testes (n = 81) and prostate (n = 9). Conclusions: Urogenital tuberculosis is rare in Japan, but patients do exist, and we should not ignore them.Key words: nationwide survey, urinary tract infection, urogenital tuberculosis. IntroductionThere are various symptoms of TB, some of which indicate a delayed allergic reaction to Mycobacterium tuberculosis. As tuberculosis is primarily a sinopulmonary infection, the lungs are most commonly affected, but other infection sites are also possible. Tuberculosis is thus classified into two categories: PTB and EPTB.1 Most EPTB, including UTB, develop after PTB. In Japan, TB incidence has decreased from 698.4 patients per 100 000 people per year in 1951 to 19.0 patients per 100 000 people per year in 2009. 2 In 2008, just 121 urinary tract TB patients and 34 genital TB patients were reported.3 Therefore, Japanese urologists seldom encounter UTB patients in common practice. However, UTB can occur several decades after the initial TB infection. 4 The Tuberculosis Surveillance Center, which is part of the Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association, provides epidemiological data on TB incidence in Japan, the number of EPTB patients and modes of treatment of all EPTB (including UTB).5 However, there is generally very little information about UTB patients. The present study examined the following: the number of recent UTB patients, the social and medical background of UTB patients, the role of urinary examination in UTB diagnosis, the incidence of drug-resistant UTB, the causes of doctor's delay, and UTB treatment options. The academic committee of the Japanese Urological Association approved the study. MethodsA questionnaire was sent to 1203 Japanese hospitals with urological departments in April 2007. Clinical data was reviewed retrospectively; no time range was specified. The questionnaire collected information in the following seven categories: (i) patient background; (ii) clinical examinations; (iii) grounds for diagnosis; (iv) patient and doctor delay; (v) mode of therapy; (vi) prognosis; and (vii) infection control. In the "patient background" category, we collected the following information: patient's sex, age at diagnosis, mode of symptoms, history of tuberculosis (lung, pleura, lymph nodes, bone and others); underlying disease (diabetes mellitus, end stage renal disease, HIV infection and others), socioeconomic backgrounds (coming from other coun...

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“…In order to eliminate the disease, early detection of LTBI and TB through screening pathway along with appropriate treatment in high-risk groups is highly recommended by the World Health Organization (WHO) guidelines and endorsed by the End TB Strategy [ 17 – 19 ]. In Japan, older people are prioritized for TB screening program in facilities for the aged [ 20 ]. In the USA, screening for LTBI and TB is recommended to older people being newly admitted to long-term care facilities [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area

Yip

Leung

et al. 2018

PLoS ONE

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BackgroundTuberculosis (TB) in the elderly remains a challenge in intermediate disease burden areas like Hong Kong. Given a higher TB burden in the elderly and limited impact of current case-finding strategy by patient-initiated pathway, proactive screening approaches for the high-risk group could be optimal and increasingly need targeted economic evaluations. In this study, we examined whether and under what circumstance the screening strategies are cost-effective compared with no screening strategy for the elderly at admission to residential care homes.MethodsA decision analytic process based on Markov model was adopted to evaluate the cost-effectiveness of four strategies: (i) no screening, (ii) TB screening (CXR) and (iii) TB screening (Xpert) represent screening for TB in symptomatic elderly by chest X-ray and Xpert® MTB/RIF respectively, and (iv) LTBI/TB screening represents screening for latent and active TB infection by QuantiFERON®-TB Gold In-Tube and chest X-ray. The target population was a hypothetical cohort of 65-year-old people, using a health service provider perspective and a time horizon of 20 years. The outcomes were direct medical costs, life-years and quality-adjusted life-years (QALYs) measured by incremental cost-effectiveness ratio (ICER).ResultsIn the base-case analysis, no screening was the most cost-saving; TB screening (CXR) was dominated by TB screening (Xpert); LTBI/TB screening resulted in more life-years and QALYs accrued. The ICERs of LTBI/TB screening were US$19,712 and US$29,951 per QALY gained compared with no screening and TB screening (Xpert), respectively. At the willingness-to-pay threshold of US$50,000 per QALY gained, LTBI/TB screening was the most cost-effective when the probability of annual LTBI reactivation was greater than 0.155% and acceptability of LTBI/TB screening was greater than 38%. In 1,000 iterations of Monte Carlo simulation, the probabilities of no screening, TB screening (CXR), TB screening (Xpert), and LTBI/TB screening to be cost-effective were 0, 1.3%, 20.1%, and 78.6% respectively.ConclusionsScreening for latent and active TB infection in Hong Kong elderly people at admission to residential care homes appears to be highly effective and cost-effective. The key findings may be the next key factor to bring down TB endemic in the elderly population among intermediate TB burden areas.

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Japan’s national tuberculosis control strategies with economic considerations

Cited by 6 publications

References 16 publications

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Nationwide survey of urogenital tuberculosis in Japan

Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area

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