Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTBRIF A Dynamic Simulation and Economic Evaluation 英文参考文献.docVIP

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Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTBRIF A Dynamic Simulation and Economic Evaluation 英文参考文献.doc

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Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTBRIF A Dynamic Simulation and Economic Evaluation 英文参考文献

PopulationHealthImpactandCost-Effectivenessof TuberculosisDiagnosiswithXpertMTB/RIF:ADynamic SimulationandEconomicEvaluation NicolasA.Menzies1,2*,TedCohen3,4,Hsien-HoLin5,MeganMurray3,JoshuaA.Salomon1,6 1Center for Health Decision Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America, 2Institute for Technology Assessment, MassachusettsGeneralHospital,Boston,Massachusetts,UnitedStatesofAmerica,3DepartmentofEpidemiology,HarvardSchoolofPublicHealth,Boston,Massachusetts, UnitedStatesofAmerica,4DivisionofGlobalHealthEquity,BrighamandWomen’sHospital,Boston,Massachusetts,UnitedStatesofAmerica, 5GraduateInstituteof Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan, 6Department of Global Health and Population, Harvard School of Public Health, Boston,Massachusetts,UnitedStatesofAmerica Abstract Background: The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World HealthOrganizationrecommendsXpertforinitialdiagnosisinindividualssuspectedofhavingmultidrug-resistantTB(MDR- TB)orHIV-associatedTB,andmanycountriesaremovingquicklytowardadoptingXpert.Asroll-outproceeds,itisessential tounderstandthepotentialhealthimpactandcost-effectivenessofdiagnosticstrategiesbasedonXpert. MethodsandFindings:WeevaluatedpotentialhealthandeconomicconsequencesofimplementingXpertinfivesouthern African countries—Botswana, Lesotho, Namibia, South Africa, and Swaziland—where drug resistance and TB-HIV coinfection are prevalent. Using a calibrated, dynamic mathematical model, we compared the status quo diagnostic algorithm,emphasizingsputumsmear,againstanalgorithmincorporatingXpertforinitialdiagnosis.Resultswereprojected over10-and20-ytimeperiodsstartingfrom2012.Comparedtostatusquo,implementationofXpertwouldavert132,000 (95% CI: 55,000–284,000) TB cases and 182,000 (97,000–302,000) TB deaths in southern Africa over the 10y following introduction,andwouldreduceprevalenceby28%(14%–40