Costs, health effects, and ICERs for a prison of 1,000 individuals.

All costs are given in 2009 US dollars. Quality of life weights used for these analyses are shown in Table S8. Shown are total health system costs accrued and total QALYs lived by individuals in the model over the 10-y time horizon, as well as overall TB prevalence and MDR-TB prevalence at the end of 10 y. For each non-dominated strategy, the additional cost for each QALY gained was evaluated in comparison to the next best strategy, giving the ICER. A strategy is considered “dominated” if there exists an alternative strategy that is both more effective and less costly or provides greater benefits more cost-effectively. In all scenarios, starting TB prevalence was 2.78% and MDR-TB prevalence was 0.74%.aNumbers inside parentheses represent 95% confidence intervals based on the probabilistic sensitivity analysis results. While confidence intervals for many quantities are wide, there is correlation across screening strategies such that the confidence intervals around the differences between strategies are much smaller, and rank orderings of strategies are very frequently preserved. For example, sputum PCR screening produces the greatest health benefit >99.5% of the time, the greatest reduction in TB prevalence >99% of the time, and the greatest reduction in MDR-TB prevalence >99.5% of the time. These differences are reflected in the fact that while sputum PCR screening is sometimes cost-saving (CS) relative to MMR screening with sputum PCR detection of MDR-TB, it almost always produces a higher health benefit, leading to high confidence that it has a favorable ICER.bIn the table, the term “incremental” refers to comparison between non-dominated strategies and their next best alternative. Sputum PCR screening's costs, QALYs, and ICER are incremental to those of MMR screening with sputum PCR detection of MDR-TB. Dominated strategies cost more and provide less health benefit than an alternative strategy or provide fewer health benefits at a higher cost per health benefit.cMMR screening with sputum PCR detection of MDR-TB costs less and is more effective than MMR screening, the current status quo in prisons in the FSU. Hence, it dominates the current status quo and is the “reference” strategy for the analysis.dCombined MMR and symptom screening is dominated via extended dominance—i.e., its ratio of additional costs (US$60,341) to additional QALYs (85) compared to MMR screening with sputum PCR detection of MDR-TB is less favorable than for sputum PCR screening (US$765/QALY versus US$543/QALY). Therefore, if the decision maker is prepared to pay this less favorable, higher amount for additional QALYs from combined MMR and symptom screening, he or she should be prepared to implement sputum PCR screening, since it provides better value for money.

所有成本均以2009年美元计价。本分析所采用的生活质量权重详见附表S8。本结果展示了模型中个体在10年时间跨度内产生的累计卫生系统总成本与累计总质量调整生命年（QALY），以及10年期末的总体结核病（TB）患病率与耐多药结核病（MDR-TB）患病率。针对每一种非占优策略，本研究将其与次优策略对比，计算每获得1个质量调整生命年所需的额外成本，即增量成本效果比（ICER）。若存在另一种策略同时兼具更高有效性与更低成本，或以更高成本效益获取更多收益，则该策略被归类为“被占优策略”。所有模拟场景的初始结核病患病率均为2.78%，初始耐多药结核病患病率为0.74%。
a 括号内数值为基于概率敏感性分析结果得到的95%置信区间。尽管多数指标的置信区间较宽，但各筛查策略间存在相关性，使得不同策略间差异的置信区间显著收窄，且策略的排序结果通常保持稳定。例如，痰聚合酶链反应（sputum PCR）筛查在超过99.5%的模拟场景中可实现最优健康收益，在超过99%的场景中可最大程度降低结核病患病率，在超过99.5%的场景中可最大程度降低耐多药结核病患病率。上述差异体现在：尽管相较于采用耐多药结核病痰聚合酶链反应检测的MMR筛查，痰聚合酶链反应筛查有时可实现成本节约（CS），但其几乎总能带来更高的健康收益，因此有充分依据确认其增量成本效果比更具优势。
b 表格中“增量”指非占优策略与其次优替代策略的对比。痰聚合酶链反应筛查的成本、质量调整生命年及增量成本效果比均相对于采用耐多药结核病痰聚合酶链反应检测的MMR筛查计算。被占优策略相较于其他替代策略，成本更高但健康收益更低，或以更高的单位健康收益成本获取更少的健康收益。
c 相较于前苏联（FSU）监狱当前采用的MMR筛查方案，采用耐多药结核病痰聚合酶链反应检测的MMR筛查成本更低且有效性更高，因此该方案优于当前标准方案，成为本分析的“参照策略”。
d 联合MMR与症状筛查属于扩展占优方案：相较于采用耐多药结核病痰聚合酶链反应检测的MMR筛查，其额外成本（60341美元）与额外质量调整生命年（85）的比值（765美元/质量调整生命年）劣于痰聚合酶链反应筛查的比值（543美元/质量调整生命年）。因此，若决策者愿意为联合MMR与症状筛查所带来的额外质量调整生命年支付更高的、更不划算的成本，则其应当选择实施痰聚合酶链反应筛查，因为该方案的成本效益更优。