Abstract：
BACKGROUND: Latent tuberculosis infection (LTBI) remains a significant challenge, as there is no gold standard diagnostic test. Current methods used for identifying LTBI are the interferon-γ release assay (IGRA), which is based on a blood test, and the tuberculin skin test (TST), which has low sensitivity. Both these tests are inadequate, primarily because they have limitations with the low bacterial burden characteristic of LTBI. This highlights the need for the development and adoption of more specific and accurate diagnostic tests to effectively identify LTBI. Herein we estimate the cost-effectiveness of the Cy-Tb test as compared with the TST for LTBI diagnosis.
METHODS: An economic modelling study was conducted from a health system perspective using decision tree analysis, which is most widely used for cost-effectiveness analysis using transition probabilities. Our goal was to estimate the incremental cost and number of TB cases prevented from LTBI using the Cy-Tb diagnostic test along with TB preventive therapy (TPT). Secondary data such as demographic characteristics, treatment outcome, diagnostic test results and cost data for the TST and Cy-Tb tests were collected from the published literature. The incremental cost-effectiveness ratio was calculated for the Cy-Tb test as compared with the TST. The uncertainty in the model was evaluated using one-way sensitivity analysis and probability sensitivity analysis.
RESULTS: The study findings indicate that for diagnosing an additional LTBI case with the Cy-Tb test and to prevent a TB case by providing TPT prophylaxis, an additional cost of 18 658 Indian rupees (US${\\$}$223.5) is required. The probabilistic sensitivity analysis indicated that using the Cy-Tb test for diagnosing LTBI was cost-effective as compared with TST testing. If the cost of the Cy-Tb test is reduced, it becomes a cost-saving strategy.
CONCLUSIONS: The Cy-Tb test for diagnosing LTBI is cost-effective at the current price, and price negotiations could further change it into a cost-saving strategy. This finding emphasizes the need for healthcare providers and policymakers to consider implementing the Cy-Tb test to maximize economic benefits. Bulk procurements can also be considered to further reduce costs and increase savings.
METHODS: An economic modelling study was conducted from a health system perspective using decision tree analysis, which is most widely used for cost-effectiveness analysis using transition probabilities. Our goal was to estimate the incremental cost and number of TB cases prevented from LTBI using the Cy-Tb diagnostic test along with TB preventive therapy (TPT). Secondary data such as demographic characteristics, treatment outcome, diagnostic test results and cost data for the TST and Cy-Tb tests were collected from the published literature. The incremental cost-effectiveness ratio was calculated for the Cy-Tb test as compared with the TST. The uncertainty in the model was evaluated using one-way sensitivity analysis and probability sensitivity analysis.
RESULTS: The study findings indicate that for diagnosing an additional LTBI case with the Cy-Tb test and to prevent a TB case by providing TPT prophylaxis, an additional cost of 18 658 Indian rupees (US${\\$}$223.5) is required. The probabilistic sensitivity analysis indicated that using the Cy-Tb test for diagnosing LTBI was cost-effective as compared with TST testing. If the cost of the Cy-Tb test is reduced, it becomes a cost-saving strategy.
CONCLUSIONS: The Cy-Tb test for diagnosing LTBI is cost-effective at the current price, and price negotiations could further change it into a cost-saving strategy. This finding emphasizes the need for healthcare providers and policymakers to consider implementing the Cy-Tb test to maximize economic benefits. Bulk procurements can also be considered to further reduce costs and increase savings.
摘要：
背景：潜伏性结核感染（LTBI）仍然是一个重大挑战，因为没有黄金标准的诊断测试。目前用于鉴定LTBI的方法是干扰素-γ释放测定(IGRA)，这是基于血液测试，和结核菌素皮肤试验(TST),灵敏度低。这两个测试都是不够的，主要是因为它们具有LTBI的低细菌负荷特性的局限性。这凸显了开发和采用更具体和准确的诊断测试以有效识别LTBI的必要性。在此，我们评估了Cy-Tb测试与TST诊断LTBI的成本效益。
方法：使用决策树分析从卫生系统的角度进行了经济建模研究，最广泛用于使用转移概率的成本效益分析。我们的目标是使用Cy-Tb诊断测试以及TB预防性治疗（TPT）来估计LTBI预防的TB病例的增量成本和数量。次要数据，如人口统计特征，治疗结果,TST和Cy-Tb试验的诊断试验结果和费用数据来自已发表的文献.与TST相比，计算Cy-Tb测试的增量成本效益比。采用单向敏感性分析和概率敏感性分析对模型中的不确定度进行了评估。
结果：研究结果表明，为了通过Cy-Tb测试诊断额外的LTBI病例，并通过提供TPT预防来预防TB病例，需要18.658印度卢比({\\$}223.5美元)的额外费用。概率敏感性分析表明，与TST测试相比，使用Cy-Tb测试诊断LTBI具有成本效益。如果Cy-Tb测试的成本降低，这成为一种节约成本的策略。
结论：用于诊断LTBI的Cy-Tb测试在当前价格下具有成本效益，价格谈判可能会进一步将其转变为节约成本的策略。这一发现强调了医疗保健提供者和政策制定者需要考虑实施Cy-Tb测试以最大化经济效益。批量采购也可以考虑进一步降低成本和增加节约。
方法：使用决策树分析从卫生系统的角度进行了经济建模研究，最广泛用于使用转移概率的成本效益分析。我们的目标是使用Cy-Tb诊断测试以及TB预防性治疗（TPT）来估计LTBI预防的TB病例的增量成本和数量。次要数据，如人口统计特征，治疗结果,TST和Cy-Tb试验的诊断试验结果和费用数据来自已发表的文献.与TST相比，计算Cy-Tb测试的增量成本效益比。采用单向敏感性分析和概率敏感性分析对模型中的不确定度进行了评估。
结果：研究结果表明，为了通过Cy-Tb测试诊断额外的LTBI病例，并通过提供TPT预防来预防TB病例，需要18.658印度卢比({\\$}223.5美元)的额外费用。概率敏感性分析表明，与TST测试相比，使用Cy-Tb测试诊断LTBI具有成本效益。如果Cy-Tb测试的成本降低，这成为一种节约成本的策略。
结论：用于诊断LTBI的Cy-Tb测试在当前价格下具有成本效益，价格谈判可能会进一步将其转变为节约成本的策略。这一发现强调了医疗保健提供者和政策制定者需要考虑实施Cy-Tb测试以最大化经济效益。批量采购也可以考虑进一步降低成本和增加节约。
