菲律宾将结核病预防治疗扩大到5-14岁家庭接触者的成本效益分析

IF 2 Q3 INFECTIOUS DISEASES

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Pub Date : 2025-03-19 DOI:10.1016/j.jctube.2025.100519

Ghassan Ilaiwy , Jessica Keim-Malpass , Romella Tuppal , Alexander F. Ritua , Flordeliza R. Bassiag , Tania A. Thomas

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引用次数: 0

摘要

背景：由于菲律宾国家指南建议的接受程度不一，5-14岁儿童作为活动性结核病（PWTB）患者的家庭接触者（HHCs）对结核病预防治疗（TPT）的覆盖率有限。我们进行了一项成本-效果分析，评估了菲律宾儿童（5-14岁）乙型肝炎病毒感染（TBI）检测和治疗的扩展情况，以帮助国家结核病规划在乙型肝炎病毒感染儿童中选择最具成本效益的TBI检测和治疗策略。方法采用马尔可夫状态转移模型，通过结核菌素皮肤试验（TST）或干扰素释放试验（IGRA）筛选5-14岁符合条件的HHCs。测试呈阳性的患者接受以下TPT策略之一：6个月每日异烟肼（6H）， 3个月每周异烟肼和利福喷丁（3HP）， 3个月每日异烟肼加利福平（3HR）和目前不测试或治疗TBI （NTT）的做法。该分析评估了从菲律宾公共医疗保健系统的角度来看，在20年的时间范围内，每种策略的预计成本和质量调整生命年（QALY）。QALY的总成本和收益表示为增量成本效益比（ICER），比较NTT上每种策略获得的每个QALY的成本。结果我们的模型估计，将TPT覆盖范围扩大到5-14岁的HHCs将具有成本效益，其增量成本效益比（ICERs）范围从使用TST和6H时获得的1,024美元/QALY（不确定性范围：497 - 2,334）到使用IGRA和3HR时获得的2,293美元/QALY（不确定性范围：1,140 - 5,203）。这些发现对于在大范围参数值的敏感性分析是稳健的。结论将TST和6H结合使用，再结合TST和3HP，扩大TPT覆盖范围至5-14岁的HHCs具有成本效益。

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Cost effectiveness analysis of expanding tuberculosis preventive therapy to household contacts aged 5–14 years in the Philippines

Background

Children aged 5–14 years who are household contacts (HHCs) of index people with active TB disease (PWTB) have limited coverage for TB preventive therapy (TPT) due to variable uptake of the national guideline recommendations in the Philippines. We conducted a cost-effectiveness analysis evaluating the expansion of TB infection (TBI) testing and treatment among pediatric (5–14 years) HHCs of index PWTB in the Philippines to assist the National TB program in choosing the most cost-effective testing and treatment strategy for TBI among HHCs of index PWTB.

Methods

Using a Markov state transition model, eligible HHCs age 5–14 years are screened for TBI with either the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Those who test positive are then simulated to receive one of the following TPT strategies: 6 months of daily isoniazid (6H), 3 months of weekly isoniazid and rifapentine (3HP), 3 months of daily isoniazid plus rifampicin (3HR) and the current practice of no testing or treatment for TBI (NTT). The analysis assesses the projected cost and quality-adjusted life years (QALY) gained for every strategy from the perspective of the Philippines public healthcare system over a time horizon of 20 years. The total cost and gain in QALYs are presented as an incremental cost-effectiveness ratio (ICER) comparing cost per QALY gained for each strategy over NTT.

Results

Our model estimates that expanding TPT coverage to HHCs aged 5–14 years would be cost-effective with incremental cost-effectiveness ratios (ICERs) ranging from 1,024 $/QALY gained when using TST and 6H (Uncertainty range: 497–––2,334) to 2,293 $/QALY gained when IGRA and 3HR are used (Uncertainty range: 1,140 – 5,203). These findings were robust to sensitivity analyses over a wide range of parameter values.

Conclusion

Expanding TPT coverage to HHCs aged 5–14 years is cost-effective when using TST and 6H closely followed by a strategy combining TST and 3HP.

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来源期刊

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine

CiteScore

4.00

自引率

5.00%

发文量

审稿时长

30 weeks

期刊介绍： Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.