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Impact and cost-effectiveness of improved diagnostics for tuberculosis in high-burden countries.

机译：高负担国家改进结核病诊断方法的影响和成本效益。

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摘要

Background. In crafting effective tuberculosis (TB) control strategies, policymakers, researchers, and funding agencies must decide how to prioritize the development and deployment of improved diagnostic testing.;Methods. Four studies were conducted. The first two studies use dynamic compartmental models of TB epidemics to estimate the potential impact of enhanced diagnostics, both in a hypothetical population with high HIV prevalence (Study I) and in the South African population, with consideration of drug-resistant TB strains (Study II). The latter two incorporate decision-analysis frameworks to estimate the cost-effectiveness of specific diagnostic interventions, including a hypothetical point-of-care test for TB (Study III) and a centralized TB culture program as implemented in urban Brazil (Study IV).;Results. In a hypothetical population, enhanced diagnostic techniques may reduce TB prevalence and mortality by 20% or more, an impact similar to that of active case-finding in 33% of the general community. Performing TB culture and drug susceptibility testing in 37% of new cases and 85% of previously-treated cases in South Africa was projected to reduce TB mortality by 17.2% (95% simulation interval [SI] 8.9-24.4%) and multidrug-resistant (MDR-) TB mortality by 46.6% (95% SI 32.6-56.0%) over 10 years. A new TB diagnostic with 90% sensitivity, 95% specificity, and price of ;Conclusions. Improved TB diagnostics could contribute substantially to TB control in high-burden countries, particularly in regions with weak existing diagnostic infrastructure. In deploying enhanced TB diagnostics, reliable transmission of results to patients and effective integration with existing clinical systems must be assured.
机译：背景。在制定有效的结核病（TB）控制策略时，决策者，研究人员和资助机构必须决定如何确定改进的诊断测试的开发和部署的优先顺序。方法。进行了四项研究。前两项研究使用动态的结核病流行区隔模型来评估增强诊断的潜在影响，无论是在HIV感染率较高的假设人群中（研究I）还是在南非人群中，考虑到耐药结核菌株（研究） II）。后两者结合了决策分析框架，以评估特定诊断干预措施的成本效益，包括针对结核病的假设性即时检验（研究三）和在巴西城市实施的集中式结核病文化计划（研究四）。 ; 结果。在假设的人群中，增强的诊断技术可将结核病的患病率和死亡率降低20％或更多，其影响类似于在33％的普通社区中积极寻找病例的影响。在南非，有37％的新病例和85％的先前治疗过的病例进行TB培养和药敏试验，预计将使TB死亡率降低17.2％（95％模拟间隔[SI] 8.9-24.4％）和多药耐药性（MDR-）结核病死亡率在10年中降低了46.6％（95％SI 32.6-56.0％）。一种新的结核病诊断方法，具有90％的敏感性，95％的特异性和价格； 结论。改善结核病诊断可以在高负担国家，特别是在现有诊断基础设施薄弱的地区，对结核病控制做出重大贡献。在部署增强型结核病诊断方法时，必须确保将结果可靠地传递给患者并与现有临床系统有效整合。

著录项

  • 作者

    Dowdy, David W.;

  • 作者单位

    The Johns Hopkins University.;

  • 授予单位 The Johns Hopkins University.;
  • 学科 Health Sciences Public Health.;Health Sciences Epidemiology.
  • 学位 Ph.D.
  • 年度 2008
  • 页码 217 p.
  • 总页数 217
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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