Cost-effectiveness analysis of tuberculosis screening in diabetic patients in China: a decision-analytic Markov model

Abstract

Objective: To establish a pharmacoeconomic model to evaluate the cost-effectiveness of various screening strategies for latent tuberculosis infection (LTBI) in older diabetic patients and provide evidence for health policy formulation. Methods: A decision tree-Markov model was constructed to simulate the LTBI screening process for 10,000 diabetic patients aged 60 years and older, analyzing the costs and health utilities of different screening strategies. Results: The incremental cost-effectiveness ratio (ICER) of the traditional tuberculin skin test (TST) strategy was significantly lower than the willingness-to-pay threshold, indicating its economic advantage. Meanwhile, the economic benefit of the new recombinant tuberculosis fusion protein skin test (C-TST) compared to TST was not significant, and the interferon-gamma release assay (IGRA) was considered the least cost-effective option due to its high cost. One-way sensitivity analysis identified key parameters that affect the economic viability of screening strategies, such as non-tuberculous mortality rates by age group, LTBI mortality rates, and annual medical costs associated with diabetes. When the non-tuberculous mortality rate reached a certain threshold, the economic viability of all screening strategies was impacted. Additionally, probabilistic sensitivity analysis indicated that TST had a high probability (70%) of being the most cost-effective screening option at a common willingness-to-pay threshold. Conclusion: Screening for LTBI in older diabetic patients is a cost-effective approach. The strategy should take into account economic conditions and healthcare resource allocation in various regions to enhance the effectiveness of public health interventions.