关键词: 糖尿病, 结核, 肺, 多相筛查, 成本及成本分析, 费用效益分析

Abstract: Objective In order to provide reference for the relevant policy making by government, a cost-effectiveness analysis of tuberculosis (TB) screening in patients with diabetes was conducted. Methods The related data and information were collected from the patients with diabetes aged 15 years old or above and were registered by Xuhui District CDC of Shanghai in June 2014 or June 2015 respectively through the diabetes management information system which was based on a comprehensive management platform of chronic disease in Xuhui District, Shanghai. Finally, 32800 patients who were registered in 2014 and 33723 patients who were registered in 2015 were enrolled into this analysis and received TB screening free of charge. The screening date was arranged in August and September each year. One month before the screening date, the enrolled patients were informed by phone call or visiting to come to the community health service centers at the appointed time for TB screening on the spot using digital radiography (DR). SPSS 17.0 software was used for statistical analysis to the following data: TB screening cost which was considered as the total social costs, including the investment of the health sector (explicit cost) and the cost of chest X-ray film which provided by the diabetes patients (implicit cost), Social effect, Social benefit, Cost-effectiveness ratio, Benefit-cost ratio. Fisher’s exact probability method was used to compare the counting data with P<0.05 as the statistical significance. Results A total of 38617 diabetes patients (19723 cases in 2014 and 18894 cases 2015) received TB screening with DR (21030 cases received DR screening on the spot while 17587 cases provided the chest X-ray examination reports). Out of 38617 patients, 9944 patients participated in the screening in both years, so in actually 28673 patients received TB screening in two years. A total of 9 pulmonary TB patients were found during the screening in 2014 and 2015. Those detected patients aged above 50 years; the detection rate was 25.35/100000 (5/19723) and 21.17/100000 (4/18894) respectively in 2014 and 2015; the detection rate of pulmonary TB in the male diabetes patients (64.98/100000, 8/12311) was significantly higher than that in the female diabetes patients (6.11/100000, 1/16362) (Fisher’s exact probability method, P=0.006). The results of cost-effectiveness analysis showed that the total expenditure of social cost in the screening was RMB 3089400 yuan and the explicit cost investment by the health sector was RMB 1858300 yuan. The TB screening could reduce the TB death by 2.25 cases, avoid TB infection by 67.50-101.25 healthy people, reduce social medical expenses by RMB 381800-572800 yuan, avoid 85.5 DALY losses and recover the indirect social value by RMB 5756600 yuan. The social cost-effectiveness ratio was RMB 36100 yuan (3089400/85.5), and the dominant cost-effectiveness ratio was RMB 21700 yuan (1858300/85.5). The social benefit-cost ratio was 2.02 ((477300+5756600)/3089400) and the dominant benefit-cost ratio was 3.35 ((477300+5756600)/1858300). Conclusion The benefit-cost ratio of TB screening with chest X-ray in diabetic patients in Xuhui District is not high, so it is not suitable for large-scale TB screening; attention should be paid to TB screening in male and elderly patients with diabetes mellitus.

Key words: Diabetes mellitus, Tuberculosis, pulmonary, Multiphasic screening, Costs and cost analysis, Cost-effectiveness analysis