Cost-effectiveness of contact screening strategies for tuberculosis among high-school adolescents in South Korea

초록

BACKGROUND: Effective latent tuberculous infection (LTBI) control among adolescents is a critical component of tuberculosis (TB) elimination in Korea. OBJECTIVE: To compare the cost-effectiveness of the following contact screening strategies for LTBI among high-school adolescents after TB outbreaks: Quanti-FERON (R)-TB Gold In-Tube (QFT-GIT), the tuberculin skin test (TST), or TST/QI-T-GIT (two-step strategy). METHOD: The costs of post-TB outbreak screening strategies were calculated using a mixed (top-down and bottom-up) cost analysis method and expressed in 2015 US dollars. Cost-effectiveness was evaluated using a decision analysis model from the health system perspective, comparing cumulative health care costs and the total number of TB cases averted. RESULTS: In a hypothetical cohort of 1000 students, screening using the TST-alone strategy averted 1.6 TB cases at a total cost of US$52566.TheQI-T-GIT-alonestrategyhelpedavert2.0TBcases,butwasassociatedwithamuchhighertotalcost(US$108 435), resulting in an incremental cost-effectiveness ratio of US$140933/TBcaseaverted.Thetwo-stepTST/QFT-GITstrategywasworsethantheTST-alonestrategy,averting1.3TBcasesatUS$75 267. CONCLUSION: The TST-alone strategy was the most cost-effective; the QFT-GIT-alone strategy averted the greatest number of TB cases but incurred the highest cost in contact investigation for school TB outbreaks.

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