보건행정학회지 (Health Policy and Management)

  • 제23권4호
  • /
  • Pages.349-357
  • /
  • 2013
  • /
  • 1225-4266(pISSN)
  • /
  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
권호 표지
DOI QR코드

DOI QR Code

우리나라 잠복결핵감염 검진전략의 경제성 분석

Economic Analysis of Latent Tuberculosis Infection Screening Strategies in Korea

  • 김상원 (충북대학교 의과대학 의료정보학 및 관리학교실) ;
  • 강길원 (충북대학교 의과대학 의료정보학 및 관리학교실) ;
  • 신삼철 (충북대학교 의과대학 의료정보학 및 관리학교실) ;
  • 송승은 (충북대학교 의과대학 의료정보학 및 관리학교실)
  • Kim, Sang-Won (Department of Health Informatics and Management, Chungbuk National University College of Medicine) ;
  • Kang, Gil-Won (Department of Health Informatics and Management, Chungbuk National University College of Medicine) ;
  • Shin, Sam-Chul (Department of Health Informatics and Management, Chungbuk National University College of Medicine) ;
  • Song, Seung-Eun (Department of Health Informatics and Management, Chungbuk National University College of Medicine)
  • 투고 : 2013.08.28
  • 심사 : 2013.12.16
  • 발행 : 2013.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Although interferon-gamma release assay (IGRA) is now available alternatives to tuberculin skin test (TST) for detection of latent tuberculosis infection (LTBI), the cost of IGRA test is much higher than TST. So economic analysis of LTBI screening strategies have been done in many countries, but there are few reports in Korea. This study examined cost analysis of LTBI screening strategies in Korea. Methods: The economic outcomes were evaluated by five strategies. These were 1) TST alone, 2) IGRA alone, 3) combination of TST and IGRA (TST followed by IGRA) and 4) no testing no prevention, 5) no testing all prevention. Last two strategies were added to compare with three main LTBI screening strategies. Decision analysis model were used to perform economic analysis. A cohort study of Korean Institute of Tuberculosis and the data of published literatures were used to estimate the cost analysis. Results: In a base-case scenario which was assumed that TST specificity was 80%, TST alone was the least expensive strategy. In a alternative scenario which was assumed that TST specificity was 97%, the combination of TST and IGRA was the least expensive strategy. Sensitivity analysis shows that patients adherent rate to LTBI treatment, TST sensitivity, IGRA sensitivity and IGRA specificity did not have a significant impact on the outcomes. Conclusion: In Korea, for the diagnosis of LTBI at the time of child and adolescent, TST alone reduces medical costs compared with IGRA alone or combination of TST and IGRA.

키워드

참고문헌

  1. Park JS. Prevalence and risk factors for mycobacterium tuberculosis infection among contacts of pulmonary tuberculosis patients. Tuberc Respir Dis 2012;72(2):140-148. https://doi.org/10.4046/trd.2012.72.2.140
  2. Mack U, Migliori GB, Sester M, Rieder HL, Ehlers S, Goletti D, et al. LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement. Eur Respir J 2009;33(5):956-973. https://doi.org/10.1183/09031936.00120908
  3. Shim TS. Diagnosis and treatment of latent tuberculosis infection. Korean J Med 2012;82(3):284-290. https://doi.org/10.3904/kjm.2012.82.3.284
  4. Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K, et al. Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection - United States, 2010. MMWR Recomm Rep 2010;59(RR-5):1-25.
  5. National Institute for Health and Clinical Excellence. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. London: Royal College of Physicians; 2006.
  6. Joint Committee for the Development of Korean Guidelines for Tuberculosis, Korea Centers for Disease Control and Prevention. Korean guidelines for tuberculosis. Seoul: MEDrang Inc.; 2011.
  7. Kim HJ. A cohort study of high-risk populations infected with M. tuberculosis. Seoul: Korean Institute of Tuberculosis; 2011.
  8. Choi YS, Baek SJ, Im ES, Lee HW, Jang HJ. 2009 Medical expenses survey of patient with national health insurance. Research report 2010. pp. 68-73.
  9. Park IN, Hong SB, Oh YM, Lim CM, Lee SD, Koh Y, et al. Comparison of effectiveness and adverse reactions between isoniazid 300 mg and 400 mg in Korean patients with pulmonary tuberculosis. Tuberc Respir Dis 2006;60(1):44-48. https://doi.org/10.4046/trd.2006.60.1.44
  10. LoBue PA, Moser KS. Use of isoniazid for latent tuberculosis infection in a public health clinic. Am J Respir Crit Care Med 2003;168(4):443-447. https://doi.org/10.1164/rccm.200303-390OC
  11. Pai M, Zwerling A, Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 2008;149(3):177-184. https://doi.org/10.7326/0003-4819-149-3-200808050-00241
  12. Reichler MR, Reves R, Bur S, Thompson V, Mangura BT, Ford J, et al. Evaluation of investigations conducted to detect and prevent transmission of tuberculosis. JAMA 2002;287(8):991-995. https://doi.org/10.1001/jama.287.8.991
  13. Diel R, Schaberg T, Loddenkemper R, Welte T, Nienhaus A. Enhanced cost-benefit analysis of strategies for LTBI screening and INH chemoprevention in Germany. Respir Med 2009;103(12):1838-1853. https://doi.org/10.1016/j.rmed.2009.07.008
  14. Menzies D, Dion MJ, Rabinovitch B, Mannix S, Brassard P, Schwartzman K. Treatment completion and costs of a randomized trial of rifampin for 4 months versus isoniazid for 9 months. Am J Respir Crit Care Med 2004;170(4):445-449. https://doi.org/10.1164/rccm.200404-478OC
  15. Menzies D, Long R, Trajman A, Dion MJ, Yang J, Al Jahdali H, et al. Adverse events with 4 months of rifampin therapy or 9 months of isoniazid therapy for latent tuberculosis infection: a randomized trial. Ann Intern Med 2008;149(10):689-697. https://doi.org/10.7326/0003-4819-149-10-200811180-00003
  16. Page KR, Sifakis F, Montes de Oca R, Cronin WA, Doherty MC, Federline L, et al. Improved adherence and less toxicity with rifampin vs isoniazid for treatment of latent tuberculosis: a retrospective study. Arch Intern Med 2006;166(17):1863-1870. https://doi.org/10.1001/archinte.166.17.1863
  17. Kang YA, Lee HW, Yoon HI, Cho B, Han SK, Shim YS, et al. Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 2005;293(22):2756-2761. https://doi.org/10.1001/jama.293.22.2756
  18. Lee JY, Choi HJ, Park IN, Hong SB, Oh YM, Lim CM, et al. Comparison of two commercial interferon-gamma assays for diagnosing Mycobacterium tuberculosis infection. Eur Respir J 2006;28(1):24-30. https://doi.org/10.1183/09031936.06.00016906
  19. Deuffic-Burban S, Atsou K, Viget N, Melliez H, Bouvet E, Yazdanpanah Y. Cost-effectiveness of QuantiFERON-TB test vs. tuberculin skin test in the diagnosis of latent tuberculosis infection. Int J Tuberc Lung Dis 2010;14(4):471-481.
  20. Health Insurance Review and Assessment Service. Guidelines for economic evaluation of pharmaceuticals in Korea. Seoul: Health Insurance Review and Assessment Service; 2011.
  21. Nienhaus A, Schablon A, Costa JT, Diel R. Systematic review of cost and cost-effectiveness of different TB-screening strategies. BMC Health Serv Res 2011;11:247. https://doi.org/10.1186/1472-6963-11-247
  22. Bae JM, Kim EH, Wang OB. An usefulness of in vitro interferon gamma assay for the diagnosis of latent tuberculosis infection in middle- and high-school students in Jeju-Shi, Korea. Tuberc Respir Dis 2010;68(3):155-161. https://doi.org/10.4046/trd.2010.68.3.155
  23. Aissa K, Madhi F, Ronsin N, Delarocque F, Lecuyer A, Decludt B, et al. Evaluation of a model for efficient screening of tuberculosis contact subjects. Am J Respir Crit Care Med 2008;177(9):1041-1047. https://doi.org/10.1164/rccm.200711-1756OC
  24. Diel R, Nienhaus A, Lange C, Schaberg T. Cost-optimisation of screening for latent tuberculosis in close contacts. Eur Respir J 2006;28(1):35-44. https://doi.org/10.1183/09031936.06.00011806