Health Economic Evaluation Of Tuberculosis Screening Strategy For Close Contacts Based On Decision Tree-Markov Model

Objective: Closer contact screening is a cost-effective patient detection measure.How to formulate an effective tuberculosis screening plan for close contacts and measure the cost-effectiveness is crucial.Based on the simulated cohort of close contacts of pathogenic positive pulmonary tuberculosis in Xinjiang,this study obtained important model parameters that meet the epidemic situation,disease burden,social and economic development status of tuberculosis in Xinjiang,evaluated the active screening strategy under the health economics indicators,selected the active screening strategy with higher cost effectiveness,and studied how to evolve and allocate the limited health resources with high quality,To provide scientific basis for the early detection and prevention strategies of tuberculosis in Xinjiang.Methods: The Tree Age Pro 2011 software was used to construct a decision tree-Markov model for the screening strategy of close contacts of patients with pathogenic positive pulmonary tuberculosis in Xinjiang.100000 close contacts aged 15～65were simulated for 20 cycles to obtain the state transfer probability,cost parameters,utility value parameters,etc.required by the model.With the passive screening strategy as the baseline,compare the number of tuberculosis patients,tuberculosis deaths,and QALY obtained by the active screening strategy once a year,the discontinuous active screening strategy twice a lifetime,and the active screening strategy once a year compared with the passive screening strategy;The cost-effectiveness analysis of active screening strategy and passive screening strategy was carried out,and the strategy was discussed with the level of willingness to pay as a reference.Conduct single-factor sensitivity analysis and probability sensitivity analysis to test the impact of assumptions and parameter estimates in the model on the model simulation results.Results: Compared with the passive screening strategy,the incidence of latent infection,the incidence rate of active tuberculosis,and the incidence of tuberculosis deaths of the lifelong active screening strategy,the lifelong two discontinuous active screening strategy,and the annual active screening strategy decreased in turn,and the QALYs obtained increased in turn.The cost of each additional QALY was 13492.5 yuan,11001.8 yuan,and 116651.7 yuan,which were lower than the WTP threshold standard,The cost increase of additional 1QALY is completely worthwhile.The three active screening strategies have cost-effectiveness advantages.Sensitivity analysis showed that ICUR was the most sensitive to the change of X-ray chest film cost.The second is the discount rate.The probability sensitivity analysis indicates that the simulation results of the model are stable and reliable;The results of the willingness to accept curve show that when the WTP increases by 185175 yuan,the probability of the cost-effectiveness of the annual active screening strategy will increase and become the most advantageous strategy.Conclusion:Based on the preference of low cost,lifelong active screening is an advantage strategy.Based on the low cost and high return preference of ICUR,two discontinuous active screening in life is the advantage strategy.Based on the preference for effect,active screening once a year is an advantage strategy.When carrying out tuberculosis active screening work,it is also necessary to combine local tuberculosis epidemic situation,social and economic development and other factors to adjust measures to local conditions,use health economics evaluation model to solve the balance between low cost and high income,and study how to evolve high-quality allocation of limited health resources.Continuous active screening for close contacts has high cost-effectiveness value and is an economic and effective public health intervention measure.