Screening for pulmonary tuberculosis in high-risk groups of diabetic patients

• Published in: International journal of infectious diseases Vol. 93; pp. 84 - 89
• Main Authors: Ji, Ye, Cao, Hengfu, Liu, Qiao, Li, Zhongqi, Song, Huan, Xu, Dian, Tian, Dan, Qiu, Beibei, Wang, Jianming
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.04.2020; Elsevier
• Subjects: Diabetes mellitus; Economic evaluation; Risk factors; Tuberculosis; Tuberculosis; Diabetes mellitus; Risk factors; Economic evaluation
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2020.01.019

•It is feasible but uneconomical to conduct large-scale and regular chest X-ray screening for tuberculosis (TB) in diabetic patients.•It is more economical to select a high-risk population for TB screening than to select all diabetes patients.•It is recommended that diabetic patients with a low body mass index, high fasting blood glucose, and low triglycerides are selected as subjects for TB screening. The double burden of diabetes mellitus (DM) and tuberculosis (TB) has attracted increasing attention, because DM not only increases the risk of active TB but also affects treatment outcomes. Screening for TB among diabetic patients has been recommended, but requires real-world evidence by considering its cost-effectiveness, cost–utility ratio, and cost–benefit ratio. A screening program was conducted in Jiangyin City of Jiangsu Province, China. A total of 14 869 diabetic patients received regular physical examinations for three consecutive years and were followed for the diagnosis of TB. The cost of screening and the effectiveness, utility, and social benefits attributed to the program were evaluated. In addition, a matched case–control study was conducted and the nomogram was used to identify high-risk groups that could be the target population for screening. Among the 14 869 diabetic patients who participated in this screening program, 22 were diagnosed with TB, resulting in an incremental cost-effectiveness ratio (ICER) of 83 910 CNY per disability-adjusted life-year (DALY) gained and a cost–benefit ratio of 0.50. If the screening program was limited to high-risk diabetic patients by considering body mass index (BMI), fasting blood glucose (FBG), and triglycerides, the ICER decreased to 34 303 CNY per DALY gained and the cost–benefit ratio increased to 1.22. Screening for TB using regular chest X-ray examinations is feasible but not economical in areas with a low incidence of TB. It is recommended that diabetic patients with a low BMI, high FBG, and low triglycerides are selected as subjects for TB screening.