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2024年重庆市学生结核分枝杆菌潜伏感染筛查方法例均成本效益分析

Cost-effectiveness per case of different screening methods for latent infection of mycobacterium tuberculosis in the student population in Chongqing,2024

  • 摘要:
    目的 分析重庆市学生结核分枝杆菌(MTB)潜伏感染筛查方法的例均成本效益,为优化大规模学生结核病筛查提供科学依据。
    方法 于2024年1—12月在重庆市开展疫情处置的46所中学46 531名高一和高二年级在校学生中,分别采用结核菌素皮肤试验(TST)和重组结核分枝杆菌融合蛋白皮肤试验(EC-ST),进行结核病健康体检和密切接触者筛查(密筛)。比较TST与EC-ST在结核病健康体检和密筛中的阳性检出情况及成本效益。
    结果 结核病健康体检中,重庆市学生TST和EC-ST检测出的MTB感染率分别为35.74%(8132/22 751)和5.73%(1 304/22 748);每检出1例MTB感染者的平均费用分别为83.93元和872.24元;结核病密筛中,重庆市学生TST和EC-ST检测出的MTB感染率分别为46.36%(210/453)和6.74%(39/579);每检出1例MTB感染者的平均费用分别为64.71元和742.31元;EC-ST检出的39例MTB感染者中检出8例结核病患者;例均检出费用为7 237.50元。TST检出的210例MTB感染者中未检出结核病患者。
    结论 EC-ST适用于高风险密接人群的精准筛查;TST成本低廉,仍是普通学生人群大规模结核病健康体检的合理选择。

     

    Abstract:
    Objective To analyze the cost-effectiveness per case of different screening methods for latent infection of mycobacterium tuberculosis (MTB) in the student population in Chongqing, thus providing a scientific basis for optimizing large-scale tuberculosis screening among students.
    Methods The tuberculin skin test (TST) and recombinant MTB fusion protein skin test (EC-ST) were adopted to conduct tuberculosis examination and close contact screening among 46 531 students in grades one and two of 46 senior high schools in Chongqing from January to December 2024. The positive detection and cost-effectiveness of TST and EC-ST in tuberculosis examination and close contact screening were compared.
    Results The infection rates of MTB detected by TST and EC-ST were 35.74% (8 132/22 751) and 5.73% (1 304/22 748), respectively. The average detection cost per case of MTB infection was 83.93 CNY for TST and 872.24 CNY for EC-ST. In the close contact screening, the infection rates of MTB detected by TST and EC-ST were 46.36% (210/453) and 6.74% (39/579), respectively. The average detection cost per case of MTB infection was 64.71 CNY for TST and 742.31 CNY for EC-ST. Among the 39 MTB-infected patients detected by EC-ST, 8 tuberculosis patients were detected, and the average detection cost was 7 237.50 CNY. Among the 210 MTB-infected patients detected by TST, no tuberculosis patient was detected.
    Conclusions EC-ST is suitable for accurate screening of high-risk close contacts, and TST with a low cost is still a reasonable choice for large-scale tuberculosis examination in the general student population.

     

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