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Pei X, Zhong T, Yang C, Sun L, Chen M, Xu M. Cost-Effectiveness of Community-Based Active Case Finding Strategy for Tuberculosis: Evidence From Shenzhen, China. J Infect Dis 2024; 229:1866-1877. [PMID: 38262678 DOI: 10.1093/infdis/jiae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Active case finding (ACF) is a potentially promising approach for the early identification and treatment of tuberculosis patients. However, evidence on its cost-effectiveness, particularly in low- and middle-income countries, remains limited. This study evaluates the cost-effectiveness of a community-based ACF practice in Shenzhen, China. METHODS We employed a Markov model-based decision analytic method to assess the costs and effectiveness of 3 tuberculosis detection strategies: passive case finding (PCF), basic ACF, and advanced ACF. The analysis was conducted from a societal perspective on a dynamic cohort over a 20-year horizon, focusing on active tuberculosis (ATB) prevalence and the incremental cost-effectiveness ratio (ICER). RESULTS Compared to the PCF strategy, the basic and advanced ACF strategies effectively reduced ATB cases by 6.8 and 10.2 per 100 000 population, respectively, by the final year of this 20-year period. The ICER for the basic and advanced ACF strategies were ¥14 757 and ¥8217 per quality-adjusted life-year, respectively. Both values fell below the cost-effectiveness threshold. CONCLUSIONS Our findings indicate that the community-based ACF screening strategy, which targets individuals exhibiting tuberculosis symptoms, is cost-effective. This underscores the potential benefits of adopting similar community-based ACF strategies for symptomatic populations in tuberculosis-endemic areas.
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Affiliation(s)
- Xingtong Pei
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
| | - Tao Zhong
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Chongguang Yang
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Meiru Chen
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
| | - Mingming Xu
- School of Public Health (Shenzhen), Shenzhen Campus, Sun Yat-sen University, Shenzhen, China
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2
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Bian Q, Zhang Y, Xue C, Lu W, Li W, Pan F, Li Y. Global and regional estimates of tuberculosis burden attributed to high fasting plasma glucose from 1990 to 2019: emphasis on earlier glycemic control. BMC Public Health 2024; 24:782. [PMID: 38481192 PMCID: PMC10935816 DOI: 10.1186/s12889-024-18260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Previous studies have shown subjects suffering from diabetes or persistent hyperglycemia were more likely to develop tuberculosis (TB). However, the global burden of TB attributed to high fasting plasma glucose (HFPG) remains unclear. This study aimed to characterize the global, regional, and national TB burden attributed to HFPG from 1990 to 2019. METHODS With Global Burden of Disease study 2019, the numbers and age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALY) rates (ASDR) of TB attributed to HFPG at global, regional, and national levels from 1990 to 2019 were extracted. The locally weighted regression model was applied to estimate the TB burden for different socio-demographic index (SDI) regions. RESULTS Globally, the ASMR and ASDR attributed to HFPG were 2.70 (95% UI, 1.64-3.94) and 79.70 (95% UI, 50.26-112.51) per 100,000 population in 1990, respectively. These rates decreased to 1.46 (95% UI, 0.91-2.08) and 45.53 (95% UI, 29.06-62.29) in 2019. The TB burden attributed to HFPG remained high in low SDI and Central Sub-Saharan Africa regions, while it declined with most significantly in high SDI and East Asia regions. Additionally, the ASMR and ASDR of TB attributed to HFPG were significantly higher in the male and the elderly population. CONCLUSIONS The global TB burden attributable to HFPG decreased from 1990 to 2019, but remained high in low SDI regions among high-risk populations. Thus, urgent efforts are required to enhance the awareness of early glycemic control and TB treatment to alleviate the severe situation.
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Affiliation(s)
- Qin Bian
- Department of Disease Control and Prevention, Shanghai Changhai Hospital, Shanghai, China
| | - Yanjun Zhang
- Department of Disease Control and Prevention, Shanghai Changhai Hospital, Shanghai, China
| | - Chen Xue
- Department of Disease Control and Prevention, Shanghai Changhai Hospital, Shanghai, China
| | - Wenjing Lu
- Department of Disease Control and Prevention, Shanghai Changhai Hospital, Shanghai, China
| | - Wei Li
- Department of Disease Control and Prevention, Shanghai Changhai Hospital, Shanghai, China
| | - Fanqi Pan
- Department of Disease Control and Prevention, Shanghai Changhai Hospital, Shanghai, China
| | - Yi Li
- Department of Disease Control and Prevention, Shanghai Changhai Hospital, Shanghai, China.
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Uppal A, Nsengiyumva NP, Signor C, Jean-Louis F, Rochette M, Snowball H, Etok S, Annanack D, Ikey J, Khan FA, Schwartzman K. Active screening for tuberculosis in high-incidence Inuit communities in Canada: a cost-effectiveness analysis. CMAJ 2021; 193:E1652-E1659. [PMID: 34725112 PMCID: PMC8565977 DOI: 10.1503/cmaj.210447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Active screening for tuberculosis (TB) involves systematic detection of previously undiagnosed TB disease or latent TB infection (LTBI). It may be an important step toward elimination of TB among Inuit in Canada. We aimed to evaluate the cost-effectiveness of community-wide active screening for TB infection and disease in 2 Inuit communities in Nunavik. Methods: We incorporated screening data from the 2 communities into a decision analysis model. We predicted TB-related health outcomes over a 20-year time frame, beginning in 2019. We assessed the cost-effectiveness of active screening in the presence of varying outbreak frequency and intensity. We also considered scenarios involving variation in timing, impact and uptake of screening programs. Results: Given a single large outbreak in 2019, we estimated that 1 round of active screening reduced TB disease by 13% (95% uncertainty range −3% to 27%) and was cost saving compared with no screening, over 20 years. In the presence of simulated large outbreaks every 3 years thereafter, a single round of active screening was cost saving, as was biennial active screening. Compared with a single round, we also determined that biennial active screening reduced TB disease by 59% (95% uncertainty range 52% to 63%) and was estimated to cost Can$6430 (95% uncertainty range −$29 131 to $13 658 in 2019 Can$) per additional active TB case prevented. With smaller outbreaks or improved rates of treatment initiation and completion for people with LTBI, we determined that biennial active screening remained reasonably cost-effective compared with no active screening. Interpretation: Active screening is a potentially cost-saving approach to reducing disease burden in Inuit communities that have frequent TB outbreaks.
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Affiliation(s)
- Aashna Uppal
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Ntwali Placide Nsengiyumva
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Céline Signor
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Frantz Jean-Louis
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Marie Rochette
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Hilda Snowball
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Sandra Etok
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - David Annanack
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Julie Ikey
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Faiz Ahmad Khan
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que
| | - Kevin Schwartzman
- Montreal Chest Institute (Uppal, Khan, Schwartzman); Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation (Uppal, Nsengiyumva, Khan, Schwartzman), Research Institute of McGill University Health Centre; McGill International Tuberculosis Centre (Uppal, Nsengiyumva, Khan, Schwartzman), Montréal, Que.; Régie régionale de la santé et des services sociaux du Nunavik (Signor, Jean-Louis, Rochette); Kativik Regional Government (Snowball); Ulluriaq School (Etok), Kangiqsualujjuaq; Northern Village of Kangiqsualujjuaq (Annanack); Salluit Birth Center, Salluit (Ikey), Québec, Que.
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Uppal A, Oxlade O, Nsengiyumva NP, N'Diaye DS, Alvarez GG, Schwartzman K. Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis. BMC Public Health 2021; 21:280. [PMID: 33536003 PMCID: PMC7860224 DOI: 10.1186/s12889-021-10187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an important public health problem in Inuit communities across Canada, with an annual incidence rate in 2017 that was nearly 300 times higher than in Canadian-born non-Indigenous individuals. Social and behavioral factors that are prevalent in the North, such as commercial tobacco use, excessive alcohol use, food insecurity and overcrowded housing put individuals at higher risk for TB morbidity and mortality. We examined the potential impact of mitigation strategies for these risk factors, in reducing TB burden in this setting. METHODS We created a transmission model to simulate the epidemiology of TB in Nunavut, Canada. We then used a decision analysis model to assess the potential impact of several evidence-based strategies targeting tobacco use, excessive alcohol use, food insecurity and overcrowded housing. We predicted TB incidence, TB-related deaths, quality adjusted life years (QALYs), and associated costs and cost-effectiveness over 20 years. All costs were expressed in 2018 Canadian dollars. RESULTS Compared to a status quo scenario with no new interventions for these risk factors, the reduction strategy for tobacco use was most effective and cost-effective, reducing TB incidence by 5.5% (95% uncertainty range: 2.7-11%) over 20 years, with an estimated cost of $95,835 per TB case prevented and $49,671 per QALY gained. The addition of the food insecurity reduction strategy reduced incidence by a further 2% (0.5-3%) compared to the tobacco cessation strategy alone, but at significant cost. CONCLUSIONS Strategies that aim to reduce commercial tobacco use and improve food security will likely lead to modest reductions in TB morbidity and mortality. Although important for the communities, strategies that address excess alcohol use and overcrowding will likely have a more limited impact on TB-related outcomes at current scale, and are associated with much higher cost. Their benefits will be more substantial with scale up, which will also likely have important downstream impacts such as improved mental health, educational attainment and food security.
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Affiliation(s)
- Aashna Uppal
- Montreal Chest Institute, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Olivia Oxlade
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
| | - Ntwali Placide Nsengiyumva
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
| | - Dieynaba S N'Diaye
- Montreal Chest Institute, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, Department of Medicine, Division of Respirology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Schwartzman
- Montreal Chest Institute, Montreal, Quebec, Canada.
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Jain V, Crosby L, Baker P, Chalkidou K. Distributional equity as a consideration in economic and modelling evaluations of health taxes: A systematic review. Health Policy 2020; 124:919-931. [PMID: 32718790 DOI: 10.1016/j.healthpol.2020.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE/SETTING The extent to which distributional equity is incorporated into evaluations of the (potential or observed) impact of health taxes is unclear. This systematic review of economic and modelling evaluations investigating taxation on tobacco, sugar-sweetened-beverages (SSBs), or alcohol aims to assess the proportion that have considered distributional impact by income or socioeconomic group. Secondary aims included summarising the reported distributional impacts, for both costs and health benefits. FINDINGS Of 4656 search results, 69 studies were included. The majority were economic analyses with epidemiological modelling, with studies on SSB taxes being of the highest quality. Tobacco was most commonly investigated tax, with 37 evaluations. Of these, 12 (32 %) considered distributional equity, with six (27 %) of 22 included SSB evaluations doing the same, and none for alcohol. A tobacco tax favoured lowerincome groups in the distribution of costs in all identified evaluations and for health benefits in nine out of 12 evaluations (75 %). For SSBs, four evaluations (67 %) found costs to favour low-income groups, with three (50 %) for health benefits. CONCLUSIONS Despite recommendations, evaluations of health taxes do not routinely consider the distributional impact of both costs and health benefits. Evaluations for alcohol taxation are particularly weak in this regard. Where investigated, the majority of evidence found tobacco taxation to favour low-income groups, whereas the limited evidence for SSBs is mixed.
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Affiliation(s)
- Vageesh Jain
- Institute for Global Health (IGH), University College London, UK; Public Health England, London, UK.
| | - Liam Crosby
- Institute for Epidemiology and Healthcare, University College London, London, UK; Tower Hamlets Council, London, UK
| | - Peter Baker
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
| | - Kalipso Chalkidou
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
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