Abstract:

Objective: To evaluate the cost-effectiveness of tuberculosis screening among high-risk populations in Longyan City, Fujian Province, and to explore the feasibility of implementing active tuberculosis screening within community settings. Methods: A retrospective investigation was conducted to collect screening data from high-risk populations for tuberculosis (HIV/AIDS patients, individuals aged 65 years and older, diabetic patients, and close contacts of patients with etiologically confirmed pulmonary tuberculosis, hereafter referred to as “close contacts”) in Longyan City between 2019 and 2023. A cost-effectiveness analysis was subsequently performed. For HIV/AIDS patients, both chest radiographs and sputum smear examinations were conducted irrespective of the presence of suspicious symptoms of pulmonary tuberculosis. In contrast, for individuals aged 65 and older, diabetic patients, and close contacts, initial screening was performed to identify suspicious symptoms, followed by chest radiographs and sputum smear examinations for those with positive findings. Results: Between 2019 and 2023, active screening was conducted for 4412 HIV/AIDS patients, 20142 individuals aged 65 and older, 6031 diabetic patients, and 3083 close contacts. The screening rates were 98.68% (4412/4471), 1.23% (20142/1632144), 1.67% (6031/362143), and 50.31% (3083/6128), respectively. A total of 21, 139, 67, and 30 tuberculosis cases were identified in these groups, respectively. The additional cost per tuberculosis case detected was 13446 yuan, 9274 yuan, 5239 yuan, and 6577 yuan, respectively. Conclusion: Supported by adequate funding and policies, the simultaneous use of chest radiographs and symptom screening demonstrates high effectiveness in tuberculosis screening among key populations.

Key words: Tuberculosis, Population surveillance, Active case finding, Cost-effectiveness analysis