Ye Ji1, Hengfu Cao2, Qiao Liu3, Zhongqi Li1, Huan Song1, Dian Xu1, Dan Tian1, Beibei Qiu1, Jianming Wang4. 1. Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China. 2. Department of Chronic Communicable Disease, Jiangyin Center for Disease Control and Prevention, Wuxi 214434, China. 3. Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing 210009, China. 4. Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China. Electronic address: jmwang@njmu.edu.cn.
Abstract
BACKGROUND: The double burden of diabetes mellitus (DM) and tuberculosis (TB) has attracted increasing attention, because DM not only increases the risk of active TB but also affects treatment outcomes. Screening for TB among diabetic patients has been recommended, but requires real-world evidence by considering its cost-effectiveness, cost-utility ratio, and cost-benefit ratio. METHODS: A screening program was conducted in Jiangyin City of Jiangsu Province, China. A total of 14 869 diabetic patients received regular physical examinations for three consecutive years and were followed for the diagnosis of TB. The cost of screening and the effectiveness, utility, and social benefits attributed to the program were evaluated. In addition, a matched case-control study was conducted and the nomogram was used to identify high-risk groups that could be the target population for screening. RESULTS: Among the 14 869 diabetic patients who participated in this screening program, 22 were diagnosed with TB, resulting in an incremental cost-effectiveness ratio (ICER) of 83 910 CNY per disability-adjusted life-year (DALY) gained and a cost-benefit ratio of 0.50. If the screening program was limited to high-risk diabetic patients by considering body mass index (BMI), fasting blood glucose (FBG), and triglycerides, the ICER decreased to 34 303 CNY per DALY gained and the cost-benefit ratio increased to 1.22. CONCLUSIONS: Screening for TB using regular chest X-ray examinations is feasible but not economical in areas with a low incidence of TB. It is recommended that diabetic patients with a low BMI, high FBG, and low triglycerides are selected as subjects for TB screening.
BACKGROUND: The double burden of diabetes mellitus (DM) and tuberculosis (TB) has attracted increasing attention, because DM not only increases the risk of active TB but also affects treatment outcomes. Screening for TB among diabeticpatients has been recommended, but requires real-world evidence by considering its cost-effectiveness, cost-utility ratio, and cost-benefit ratio. METHODS: A screening program was conducted in Jiangyin City of Jiangsu Province, China. A total of 14 869 diabeticpatients received regular physical examinations for three consecutive years and were followed for the diagnosis of TB. The cost of screening and the effectiveness, utility, and social benefits attributed to the program were evaluated. In addition, a matched case-control study was conducted and the nomogram was used to identify high-risk groups that could be the target population for screening. RESULTS: Among the 14 869 diabeticpatients who participated in this screening program, 22 were diagnosed with TB, resulting in an incremental cost-effectiveness ratio (ICER) of 83 910 CNY per disability-adjusted life-year (DALY) gained and a cost-benefit ratio of 0.50. If the screening program was limited to high-risk diabeticpatients by considering body mass index (BMI), fasting blood glucose (FBG), and triglycerides, the ICER decreased to 34 303 CNY per DALY gained and the cost-benefit ratio increased to 1.22. CONCLUSIONS: Screening for TB using regular chest X-ray examinations is feasible but not economical in areas with a low incidence of TB. It is recommended that diabeticpatients with a low BMI, high FBG, and low triglycerides are selected as subjects for TB screening.
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