福建省龙岩市结核病重点高危人群主动筛查成本效果分析  

Cost-effectiveness analysis of active tuberculosis screening among high-risk populations in Longyan City, Fujian Province

作　　者：郑建莉[1] 吴语媚 张仕利 杜恣闲[1] 李土荣[1] 陈石生[1] 林文革[1] Zheng Jianli;Wu Yumei;Zhang Shili;Du Zixian;Li Turong;Chen Shisheng;Lin Wenge(Tuberculosis Prevention and Control Department,Longyan Center for Disease Control and Prevention,Fujian Province,Longyan 364000,China)

机构地区：[1]福建省龙岩市疾病预防控制中心结核病防治科,龙岩364000

出　　处：《结核与肺部疾病杂志》2025年第1期35-39,共5页Journal of Tuberculosis and Lung Disease

摘　　要：目的:分析福建省龙岩市结核病重点高危人群筛查成本-效果,探索基层开展重点人群结核病主动筛查的可行性。方法:采用回顾性调查法,收集龙岩市2019—2023年结核病重点高危人群[HIV/AIDS患者、65岁及以上老年人、糖尿病患者、病原学阳性肺结核患者密切接触者(简称“密切接触者”)]筛查数据,并进行成本-效果分析。其中,对HIV/AIDS患者无论是否有肺结核可疑症状均开展胸部X线摄片(简称“胸片”)和痰涂片检查;对65岁及以上老年人、糖尿病患者及密切接触者先开展肺结核可疑症状筛查,再对症状阳性者进行胸片和痰涂片检查。结果:2019—2023年累计对4412例HIV/AIDS患者、20142例65岁及以上老年人、6031例糖尿病患者和3083名密切接触者进行主动筛查,检查率分别为98.68%(4412/4471)、1.23%(20142/1632144)、1.67%(6031/362143)和50.31%(3083/6128),分别检出结核病患者21例、139例、67例和30例。每检出1例结核病患者分别需要额外增加成本13446元、9274元、5239元和6577元。结论:在经费和政策双重支持的情况下,在重点人群结核病筛查中,同时采用胸片和症状筛查效果好。Objective:To evaluate the cost-effectiveness of tuberculosis screening among high-risk populations in Longyan City,Fujian Province,and to explore the feasibility of implementing active tuberculosis screening within community settings.Methods:A retrospective investigation was conducted to collect screening data from high-risk populations for tuberculosis(HIV/AIDS patients,individuals aged 65 years and older,diabetic patients,and close contacts of patients with etiologically confirmed pulmonary tuberculosis,hereafter referred to as“close contacts”)in Longyan City between 2019 and 2023.A cost-effectiveness analysis was subsequently performed.For HIV/AIDS patients,both chest radiographs and sputum smear examinations were conducted irrespective of the presence of suspicious symptoms of pulmonary tuberculosis.In contrast,for individuals aged 65 and older,diabetic patients,and close contacts,initial screening was performed to identify suspicious symptoms,followed by chest radiographs and sputum smear examinations for those with positive findings.Results:Between 2019 and 2023,active screening was conducted for 4412 HIV/AIDS patients,20142 individuals aged 65 and older,6031 diabetic patients,and 3083 close contacts.The screening rates were 98.68%(4412/4471),1.23%(20142/1632144),1.67%(6031/362143),and 50.31%(3083/6128),respectively.A total of 21,139,67,and 30 tuberculosis cases were identified in these groups,respectively.The additional cost per tuberculosis case detected was 13446 yuan,9274 yuan,5239 yuan,and 6577 yuan,respectively.Conclusion:Supported by adequate funding and policies,the simultaneous use of chest radiographs and symptom screening demonstrates high effectiveness in tuberculosis screening among key populations.

关 键 词：结核 人群监测 主动筛查 成本及成本分析 

分 类 号：R521[医药卫生—内科学]