肺结核患者不同发现策略的成本效果研究

发布时间：2018-02-02 17:59

本文关键词： 肺结核患者发现决策树成本-效果分析　出处：《中国疾病预防控制中心》2013年硕士论文　论文类型：学位论文

【摘要】：目的通过研究肺结核患者不同发现策略的成本效果,确定在肺结核可疑症状者和重点人群中开展肺结核患者发现的最优策略,为卫生决策者因地制宜制定肺结核患者发现策略提供科学依据。方法 1.通过文献研究确定针对活动性肺结核患者的不同诊断技术组合； 2.通过文献研究、人群归因危险分值排序和可行性考虑,确定适合在我国开展肺结核患者发现工作的重点人群； 3.建立决策树模型,收集参数和参数敏感度分析范围,进行成本-效果分析确定每种人群的最优策略,进行敏感度分析检验模型的稳定性； 4.汇总不同人群的最优策略的成本效果,考虑相互之间的交叉重复,获得最优策略应用于全人群的成本效果。结果 1.确定了5种肺结核患者发现策略：策略1：对目标人群先进行胸部X线检查和痰涂片镜检,对有临床表现或X线检查怀疑肺结核但涂片检查阴性者进行固体痰培养；策略2：对目标人群先进行线索调查,然后对线索调查获得的可疑症状者和该目标人群中主动就诊的可疑症状者进行胸部X线检查和痰涂片镜检,对有临床表现或X线检查怀疑肺结核但涂片检查阴性者进行固体痰培养；策略3：对目标人群先进行询问症状和胸部X线检查,任何一项有异常者进行痰涂片检查,对涂阴者做痰培养；策略4：对目标人群先进行询问症状和胸部X线检查,任何一项有异常者进行痰涂片LED镜检,对涂阴者做痰培养；策略5：对目标人群先进行询问症状和胸部X线检查,任何一项有异常者进行GeneXpert检查。 2.确定的重点人群为老年人、糖尿病患者和涂阳肺结核患者密切接触者。 3.对于可疑症状者,策略2是进行患者发现的最大效果策略,策略4为最高效率策略；对于老年人群,策略3是进行患者发现的最大效果策略,策略1为最高效率策略；对于糖尿病患者和涂阳密接者,策略4是进行肺结核患者发现的最大效果策略,策略1为最高效率策略；敏感度分析显示各参数在设定的范围内变化不影响模型分析的结果。 4.最大效果策略应用于全人群花费的成本为1720.5万元,能够发现2367例肺结核患者；最高效率策略应用于全人群花费的成本为279.8万元,能够发现1387例肺结核患者。结论 1.使用痰涂片LED镜检替代痰涂片传统镜检能够获得更高的收益； 2.为了发现更多的肺结核患者,可疑症状者应采用策略2,老年人群应采用策略3,糖尿病患者和涂阳密接者应采用策略4； 3.为了实现最高效的肺结核患者发现,可疑症状者应采用策略4,老年人群、糖尿病患者和涂阳密接者应采用策略2； 4.现阶段,对所有的重点人群单独开展肺结核患者发现不符合成本效益原则,未来可以考虑在具有多重危险因素的人群中做进一步的研究。
[Abstract]:Objective to study the cost effect of different detection strategies for pulmonary tuberculosis patients, and to determine the best strategy for the detection of pulmonary tuberculosis patients among suspected symptoms and key population. To provide scientific basis for health decision makers to formulate strategies for finding tuberculosis patients according to local conditions. Method 1. To determine the different diagnostic techniques for active pulmonary tuberculosis patients through literature research; 2.Through the literature research, the classification of population attribution risk and the feasibility consideration, the key population suitable for TB discovery in China was determined. 3. Establish the decision tree model, collect the parameters and their sensitivity analysis range, make cost-effect analysis to determine the optimal strategy for each population, and test the stability of the model by sensitivity analysis. 4. Sum up the cost effect of the optimal strategy of different population, consider the crossover between each other, and obtain the cost effect of the optimal strategy applied to the whole population. Results 1. Five strategies for finding pulmonary tuberculosis patients were determined. Strategy 1: chest X-ray examination and sputum smear examination were performed on the target population first. Solid sputum culture was performed on patients with clinical manifestations or suspected pulmonary tuberculosis but negative smear examination. Strategy 2: the target group was investigated with clues first, and then chest X-ray examination and sputum smear examination were carried out on the suspicious symptoms obtained by the clue investigation and the suspicious symptoms of the target group. Solid sputum culture was performed on patients with clinical manifestations or suspected pulmonary tuberculosis but negative smear examination. Strategy 3: the target population was examined for symptoms and chest X-ray, any abnormal sputum smear examination and sputum culture for negative smear; Strategy 4: ask for symptoms and chest X-ray examination of the target population first, any one of the abnormal sputum smear LED examination, the smear negative for sputum culture; Strategy 5: ask the target group for symptoms and chest X-ray examination, any abnormal for GeneXpert examination. 2. The key population was the elderly, diabetic patients and smear positive pulmonary tuberculosis patients in close contact. 3. For patients with suspicious symptoms, strategy 2 is the most effective strategy for patient detection, and strategy 4 is the highest efficiency strategy. For the elderly, strategy 3 was the most effective strategy for patient discovery, and strategy 1 was the highest efficiency strategy. For diabetic patients and smear positive patients, strategy 4 was the most effective strategy for finding pulmonary tuberculosis, and strategy 1 was the highest efficiency strategy. Sensitivity analysis shows that the variation of the parameters within a given range does not affect the results of the model analysis. 4. The cost of applying the maximum effect strategy to the whole population is seventeen million two hundred and five thousand yuan, which can detect 2 367 cases of pulmonary tuberculosis. The maximum efficiency strategy cost two million seven hundred and ninety-eight thousand yuan to apply to the whole population, and can detect 1, 387 cases of pulmonary tuberculosis. Conclusion 1. The use of sputum smear LED to replace the traditional sputum smear examination can obtain higher income. 2. In order to find more patients with pulmonary tuberculosis, strategy 2 should be used for suspicious symptoms, strategy 3 should be adopted for the elderly, and strategy 4 should be used for diabetics and smear positive persons. 3. In order to find the most effective pulmonary tuberculosis patients, strategy 4 should be adopted for suspicious symptoms, and strategy 2 should be adopted for the elderly, diabetes patients and smear positive persons. 4. At this stage, it is not cost-effective to identify tuberculosis patients in all key populations alone, and further research in populations with multiple risk factors could be considered in the future.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R521

【参考文献】