使用移动数字化 X 射线在印度农村检测肺结核的两种策略的临床和成本效益比较。
Comparison of clinical and cost-effectiveness of two strategies using mobile digital x-ray to detect pulmonary tuberculosis in rural India.
机构信息
Department of Respiratory and Sleep Medicine, Medanta the Medicity, Gurgaon, India.
Department of Respiratory Medicine, Scarborough District Hospital, Scarborough, UK.
出版信息
BMC Public Health. 2019 Jan 22;19(1):99. doi: 10.1186/s12889-019-6421-1.
BACKGROUND
Medanta - The Medicity, a multi-super specialty corporate hospital in Gurugram, Haryana launched a "TB-Free Haryana" Campaign; mobile van equipped with a digital CXR machine to screen patients with presumptive Tuberculosis (TB).
OBJECTIVES
In this study, we aimed to assess the (1) yield and cost analysis of two strategies using mobile digital x-ray to detect Pulmonary TB in rural Haryana.
METHODS
An observational study was conducted on all individuals screened by either of the two case finding strategies using a mobile x-ray unit (MXU) mounted on a mobile van in District Mewat, Haryana during Jan-March 2016.
RESULTS
Strategy 1: Out of 121 smear negative cases, x-rays were suggestive of TB in 39(32%), of which 24 were started on TB treatment. Cost of identifying a smear negative TB was US$ 32. Strategy 2: Out of 596 presumptive TB, chest x-rays were suggestive of TB in 108 (18%), of which 67 were started on TB treatment (56 were smear negative TB). Cost of detecting any case of TB was US$ 08 (1 USD = 64 INR).
CONCLUSION
The study reports a new initiative within a PPM model to improve the diagnosis of PTB by filling the gap in the current diagnostic infrastructure. We believe there is potential for replication of strategy 2 model in other states, although further evidence is required.
背景
位于哈里亚纳邦古尔冈的多专科企业医院 Medanta - The Medicity 发起了一项“哈里亚纳邦无结核”运动；一辆配备数字化 X 光机的移动厢式车，用于筛查疑似结核病（TB）患者。
目的
本研究旨在评估两种使用移动数字 X 光机检测哈里亚纳邦农村地区肺结核病的策略的（1）检出率和成本分析。
方法
在 2016 年 1 月至 3 月期间，在哈里亚纳邦梅瓦特区，使用安装在移动厢式车上的移动 X 光机（MXU）对通过两种病例发现策略筛查的所有个体进行了一项观察性研究。
结果
策略 1：在 121 例痰涂片阴性病例中，X 光片提示结核病 39 例（32%），其中 24 例开始接受结核病治疗。发现一例痰涂片阴性结核病的成本为 32 美元。策略 2：在 596 例疑似结核病中，胸部 X 光片提示结核病 108 例（18%），其中 67 例开始接受结核病治疗（56 例为痰涂片阴性结核病）。发现一例结核病的成本为 0.08 美元（1 美元=64 印度卢比）。
结论
本研究报告了在现有的诊断基础设施中，通过填补空白，以新的公共卫生规划模式（PPM）内的倡议来改善肺结核病的诊断。我们相信，该策略 2 模型有可能在其他邦复制，尽管还需要进一步的证据。
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