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

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.