Cost-effectiveness Study Of Different Strategies For Pulmonary Tuberculosis Case Finding

Objective Through cost-effectinveness analyses of different strategies of pulmonary tuberculosis case finding, to confirm the optimal strategies for PTB case finding in PTB suspects and key groups, and provide scientific evidences of making pulmonary tuberculosis(PTB) case finding strategies for policy maker in different regions in China.Methods1. To confirm diagnostic algorithms of active puomonary tuberculosis by literature research.2. To confirm high risk groups of pulmonary tuberculosis case finding in China by literature research, population attributable fraction rankings and feasibility consideration;.3. To build decision tree models, collect parameters and scopes of the parameters, carry out cost-effectiveness analyses to confirm the optimal strategy of every groups, and carry out sensitivity analyses to check out the stability of the models.4. To gather the cost-effectiveness of the optimal strategies of different groups, taking the overlaps between each other into count, then gain the cost-effectiveness of general population.Results1. Five PTB case finding strategies have been confirmed. Strategy one:firstly, chest X-ray and sputum smear microscopy should be taken. And then, solid sputum culture may be given to those who have clinical manifestation or have been suspected pulmonary tuberculosis by chest X-ray with smear-negative. Strategy two:firstly, clue investigation should be taken to the target groups. And then, chest X-ray and sputum smear microscopy may be given to those who are symptomatic candidates going to clinic actively and from clue investigation. After all, solid sputum culture may be given to those who have clinical manifestation or have been suspected pulmonary tuberculosis by chest X-ray with smear-negative. Strategy three:firstly, symptom screening and chest X-ray should be taken. And then, sputum smear microscopy may be given to those who have clinical manifestation or have been suspected pulmonary tuberculosis by chest X-ray. If the result of smear were negative, then solid sputum culture should be taken. Strategy four:firstly, symptom screening and chest X-ray should be taken. And then, Fluorescent Light-emitting Diode (LED) sputum smear microscopy may be given to those who have clinical manifestation or have been suspected pulmonary tuberculosis by chest X-ray. If the result of smear was negative, then solid sputum culture should be given.. Strategy five:firstly, symptom screening and chest X-ray and should be taken. And then, Xpert may be given to those who have clinical manifestation or have been suspected pulmonary tuberculosis by chest X-ray.2. The confirmed key groups were elderly people, diabetes mellitus(DM) patients and close contacts of smear positive pulmonary tuberculosis.3. For PTB suspects, strategy2was the most productive one for PTB case finding, and strategy4was the most efficient one. For the elderly people, strategy3was the most productive one for PTB case finding, and strategy1was the most efficient one. For DM patients and close contacts of smear positive pulmonary tuberculosis, strategy4was the most productive one for PTB case finding, and strategy1was the most efficient one. The sensitivity analyses showed that the results of the model analyses were not effected by the scopes of the parameters.4. Implying the most productive strategies to general population, the cost was17,205,265RMB, and the effectiveness were2367PTB patients. Implying the most efficient strategies to general population, the cost was2,798,402RMB, and the effectiveness were1,387PTB patients.Conclusions1. Replacing the traditional sputum smear microscopy by Fluorescent LED sputum smear microscopy could obtain higher effectiveness.2. To find more PTB patients, case finding in PTB suspects should take strategy 2. strategy3in elderly people, and strategy4in DM patients and in close contacts of smear positive pulmonary tuberculosis.3. To be most efficient, case finding in PTB suspects should take strategy4, and strategy2in elderly people, DM patients and close contacts of smear positive pulmonary tuberculosis.4. By now, it is not fit to the cost-effectiveness principle to finding PTB patients in all key groups all alone. It may be considered to do research in groups with muitiple risks in future.