荷兰高风险移民和寻求庇护者结核病感染筛查和治疗的成本效益：一项队列模型研究

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-07-07 DOI:10.1016/j.jiph.2025.102889

Jan A.C. Hontelez , Ineke T. Spruijt , Roel Bakker , Frank Cobelens , Connie Erkens , Susan van den Hof , Sake J. de Vlas

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引用次数: 0

摘要

背景：我们评估了荷兰移民、寻求庇护者和定居移民的结核病感染（TBI）筛查和结核病预防治疗（TPT）的成本效益。方法我们使用了一个确定性队列模型，该模型捕获了原籍国（入境前）和荷兰（入境后）移民队列的TBI和结核病的自然史。我们将感染的入境前强度与干扰素γ释放试验（IGRA）的实施试点研究的阳性率和国家入境筛查计划的胸部x线片（CXR）阳性相匹配。我们比较了在20年的时间范围内TBI筛查和CXR筛查获得的每个质量调整生命年（QALY）的成本，通过对1000多个符合数据的独特参数组合进行预测，考虑了参数的不确定性。结果与目前基于cxr的筛查政策相比，stbi筛查统一导致获得的qaly增加。对于移民而言，在观察到的TPT完成率下，10 %的参数组合预测TBI入境筛查比CXR筛查更具成本效益（36 %）。然而，对于来自结核病发病率≥100 / 100,000的国家的移民，当应用TPT完成率（72 %）观察到的寻求庇护者时，这一参数组合变为近100% %。对于寻求庇护者，100 %的参数组合预测成本效益，而0 %预测TBI筛查在定居移民中具有成本效益。结论对于来自结核病高流行国家的移民和寻求庇护者，只要TPT完成率足够高，stbi入境筛查可替代CXR入境筛查。

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Cost-effectiveness of tuberculosis infection screening and treatment among high-tuberculosis risk immigrants and asylum seekers in The Netherlands: A cohort modelling study

Background

We evaluated the cost-effectiveness of TB infection (TBI) screening and TB preventive treatment (TPT) for immigrants, asylum seekers, and settled migrants in The Netherlands.

Methods

We used a deterministic cohort model that captures the natural history of TBI and TB disease for a migrant cohort in the country of origin (pre-entry) and in The Netherlands (post-entry). We fitted the pre-entry force of infection to Interferon Gamma Release Assay (IGRA) positivity rates from an implementation pilot study, and chest X-ray (CXR) positivity from the national entry-screening programme. We compared the costs per quality adjusted life year (QALY) gained for TBI screening with CXR screening over a 20-year time-horizon, accounting for parameter uncertainty by producing predictions for over 1000 unique parameter combinations that fit the data.

Results

TBI screening uniformly resulted in an increase in QALYs gained compared to current CXR-based screening policies. For immigrants, <10 % of parameter combinations predicted TBI entry screening to be more cost-effective than CXR screening under observed TPT completion rates (36 %). However, this changed to nearly 100 % of parameter combinations for immigrants coming from countries with a TB incidence of ≥100 per 100,000 when applying TPT completion rates as observed in asylum seekers (72 %). For asylum seekers, 100 % of parameter combinations predicted cost-effectiveness, while 0 % predicted TBI screening to be cost-effective among settled migrants.

Conclusions

TBI entry screening is a cost-effective alternative to CXR entry screening for immigrants and asylum seekers coming from high TB endemic countries, provided TPT completion is sufficiently high.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.