Cost-utility analysis of pulmonary tuberculosis screening among elderly patients with diabetes mellitus in Nanjing City based on a decision tree-Markov model
10.19485/j.cnki.issn2096-5087.2026.06.002
- Author:
JIANG Yan
;
WANG Rong
;
WEN Jiaxin
- Publication Type:Journal Article
- Keywords:
the elderly;
diabetes mellitus;
pulmonary tuberculosis;
active screening;
cost-utility analysis
- From:
Journal of Preventive Medicine
2026;38(6):545-549
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the cost-utility of different pulmonary tuberculosis screening programs using a decision tree-Markov model, so as to provide the theoretical basis for pulmonary tuberculosis prevention and control strategies among elderly patients with diabetes mellitus in Nanjing.
Methods:The baseline data for this study were obtained from the National Basic Public Health Service Project Management Information Platform. The baseline cohort consisted of patients with diabetes mellitus aged ≥65 years with no history of active tuberculosis and/or currently taking anti-tuberculosis medications. Based on symptoms and chest X-ray findings, three different screening protocols for pulmonary tuberculosis were developed: a passive screening protocol for patients presenting with symptoms, a two-step screening protocol involving X-ray examination following positive symptoms, and a combined screening protocol involving X-ray examination following symptom-based screening; Treeage Pro 2022 software was used to construct a decision tree-Markov model simulating the incidence and progression of pulmonary tuberculosis in elderly patients with diabetes mellitus. The incremental cost-utility ratio (ICUR) of the three screening strategies was calculated and compared in terms of yuan per quality-adjusted life year (QALY), and sensitivity analyses were performed on the model.
Results:In a simulated screening of 100 000 elderly patients with diabetes mellitus, the number of pulmonary tuberculosis cases detected by passive screening, two-step screening, and combined screening were 3 116, 4 656, and 5 086, with corresponding detection rates of 3.12%, 4.66%, and 5.09%, respectively. The differences were statistically significant (P<0.05). The number of pulmonary tuberculosis-related deaths were 513, 160, and 82, with corresponding mortality of 16.46%, 3.44%, and 1.61%, respectively, and the differences were also statistically significant (P<0.05). Compared with the passive screening strategy, the ICURs for the two-step screening and combined screening strategies were 37 546.89 yuan/quality-adjusted life-year (QALY) and 77 827.52 yuan/QALY, respectively, both of which demonstrated cost utility. Compared with the two-step screening strategy, the ICUR for the combined screening strategy was 197 395.55 yuan/QALY, demonstrating cost utility. Sensitivity analysis indicated that the results were generally robust; when the willingness-to-pay threshold was set at 241 041 yuan/QALY, the combined screening strategy had the highest probability of being cost-utility effective, at 63.70%.
Conclusions:Theoretically, the combined screening protocol for pulmonary tuberculosis, consisting of symptom screening followed by X-ray examination, is more cost-utility effective among elderly patients with diabetes mellitus in Nanjing City. Therefore, its implementation is recommended for this population.
- Full text:2026111016180869422基于决策树-马尔可夫模型的南京市老年糖尿病患者肺结核筛查成本效用分析.pdf
