Comparison of yield and relative costs of different screening algorithms for tuberculosis in active case-finding: a cross-section study

BMC Infectious Diseases

Jianwei Li¹  Wei Lu²  Chunyi Fu³  Chongguang Yang⁴  Lin Xu⁵  Feiying Liu⁶  Dingwen Lin⁶  Yanling Yu⁷  Shuangyi Hou⁸  Xiaomeng Wang⁹  Guolong Zhang^1,10  Jin Xing^1,10  Lixia Wang^1,11  Dongmei Hu^1,11  Yinyin Xia^1,11  Canyou Zhang^1,11  Jun Cheng^1,11  Hui Zhang^1,11  Fei Zhao^1,12  Xin Shen^1,13  Jianlin Wu^1,14 

[1] Center for Tuberculosis Control of Guangdong Province, Guangzhou, Guangdong, People’s Republic of China;Department of Chronic Communicable Disease, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, People’s Republic of China;Department of Emergency Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China;Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA;Division of Tuberculosis Control and Prevention, Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan, People’s Republic of China;Guangxi Provincial Center for Disease Control and Prevention, Nanning, Guangxi Zhuang Autonomous Region, People’s Republic of China;Heilongjiang Provincial Center for Tuberculosis Control and Prevention, Harbin, Heilongjiang, People’s Republic of China;Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei, People’s Republic of China;Institute of TB Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, People’s Republic of China;Institute of Tuberculosis Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, People’s Republic of China;National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China;National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China;Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China;Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA;Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China;Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, People’s Republic of China;

关键词: Tuberculosis;    Cost-effectiveness;    Active case-finding;    Screening;   

DOI  :  10.1186/s12879-021-06486-w

来源: Springer

【 摘 要 】

BackgroundPart of tuberculosis (TB) patients were missed if symptomatic screening was based on the main TB likely symptoms. This study conducted to compare the yield and relative costs of different TB screening algorithms in active case-finding in the whole population in China.MethodsThe study population was screened based on the TB likely symptoms through a face-to-face interview in selected 27 communities from 10 counties of 10 provinces in China. If the individuals had any of the enhanced TB likely symptoms, both chest X-ray and sputum tests were carried out for them furtherly. We used the McNemar test to analyze the difference in TB detection among four algorithms in active case-finding. Of four algorithms, two were from WHO recommendations including 1a/1c, one from China National Tuberculosis Program, and one from this study with the enhanced TB likely symptoms. Furthermore, a two-way ANOVA analysis was performed to analyze the cost difference in the performance of active case-finding adjusted by different demographic and health characteristics among different algorithms.ResultsAlgorithm with the enhanced TB likely symptoms defined in this study could increase the yield of TB detection in active case-finding, compared with algorithms recommended by WHO (p < 0.01, Kappa 95% CI: 0. 93–0.99) and China NTP (p = 0.03, Kappa 95% CI: 0.96–1.00). There was a significant difference in the total costs among different three algorithms WHO 1c/2/3 (F = 59.13, p < 0.01). No significant difference in the average costs for one active TB case screened and diagnosed through the process among Algorithms 1c/2/3 was evident (F = 2.78, p = 0.07). The average costs for one bacteriological positive case through algorithm WHO 1a was about two times as much as the costs for one active TB case through algorithms WHO 1c/2/3.ConclusionsActive case-finding based on the enhanced symptom screening is meaningful for TB case-finding and it could identify more active TB cases in time. The findings indicated that this enhanced screening approach cost more compared to algorithms recommend by WHO and China NTP, but the increased yield resulted in comparative costs per patient. And it cost much more that only smear/bacteriological-positive TB cases are screened in active case-finding.

【 授权许可】

CC BY