Cost-effectiveness of LTBI screening among incarcerated population in Japan

• Project/Area Number: 16K09155
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Hygiene and public health
• Research Institution: 公益財団法人結核予防会 結核研究所
• Principal Investigator: Kawatsu Lisa 公益財団法人結核予防会 結核研究所, 臨床・疫学部, 研究員(移行) (10747570)
• Co-Investigator(Kenkyū-buntansha): 内村 和広 公益財団法人結核予防会 結核研究所, 臨床・疫学部 疫学情報室, 副部長 (30247283)
• Research Collaborator: Ohkado Akihiro
• Project Period (FY): 2016-04-01 – 2019-03-31
• Project Status: Completed (Fiscal Year 2018)
• Budget Amount: ¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000); Fiscal Year 2018: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2017: ¥2,730,000 (Direct Cost: ¥2,100,000、Indirect Cost: ¥630,000); Fiscal Year 2016: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000)
• Keywords: 結核 / 潜在性結核感染症 / スクリーニング / 費用対効果分析 / 刑事施設被収容者 / 刑事施設 / 矯正医療 / インターフェロンγ遊離試験 / インターフェロン-γ遊離試験 / 公衆衛生学 / 保健医療政策 / 疫学

Outline of Final Research Achievements

We conducted a cost-effectiveness analysis of tuberculosis (TB) and latent tuberculosis (LTBI) screening for incarcerated persons in Japan, comparing TB screening by chest X-ray (CXR), LTBI screening by interferon-gamma release assay (IGRA) , and no screening for a hypothetical cohort of 10,000 persons entering prison. Cross-sectional surveys were also conducted to collect data necessary for the analysis.
Without any screening, it was estimated that 314 active cases would occur. Screening by CXR prevented one, and IGRA prevented 228 active cases. Incremental cost-effectiveness of introducing CXR screening was approximately 5,000,000 JPY, whereas that of introducing IGRA screening was approximately 130,000 JPY. Screening by CXR was ruled out as a policy option according to the principle of extended dominance.

Academic Significance and Societal Importance of the Research Achievements

刑事施設被収容者は結核のハイリスク者であり、潜在性結核感染症（LTBI)の有病率も高いとされている。従って積極的なLTBIスクリーニングの対象となり得るが、その有用性に関するエビデンスは日本では非常に限定的である。従って本研究の結果は刑事施設被収容者に対するLTBIスクリーニングの有用性に関する貴重なエビデンスを提供したことに大きな学術的意義がある。更に、本研究は、費用対効果分析に必要な幾つかのパラメータに関して実地調査を通してデータ収集した。これにより、日本では不足していた刑事施設被収容者におけるインターフェロンγ遊離試験の陽性率や、結核及びLTBIの治療成績などに関するデータも構築できた。

Research Products

• [Journal Article] 出所前及び出所後の刑事施設被収容者における結核治療の転帰 (2019)
  • Author(s): 河津里沙、内村和広、大角晃弘
  • Journal Title: 結核 Volume: 94(5)
  • Peer Reviewed
• [Journal Article] A situational analysis of latent tuberculosis infection among incarcerated population in Japan (2018)
  • Author(s): Kawatsu L, Uchimura K, Ohkado A
  • Journal Title: Plos ONE Volume: 13(9) Issue: 9 Pages: e0203815-e0203815
  • DOI: 10.1371/journal.pone.0203815
  • Peer Reviewed / Open Access
• [Journal Article] Trend and treatment status of latent tuberculosis infection patients in Japan: Analysis of Japan TB Surveillance data. (2017)
  • Author(s): Kawatsu L, Uchimura K, Ohkado A
  • Journal Title: PLoS ONE Volume: 12 Issue: 11 Pages: e0186588-e0186588
  • DOI: 10.1371/journal.pone.0186588
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Presentation] Latent tuberculosis infection among incarcerated population in Japan (2018)
  • Author(s): Kawatsu L, Uchimura K, Ohkado A
  • Organizer: The 4th China-Japan-Korea Symposium on Tuberculosis Control and Prevention
  • Int'l Joint Research
• [Presentation] Can we turn the challenge into chance? Drug abuse and tuberculosis in prisons in Japan (2017)
  • Author(s): Kawatsu L, Uchimura K, Ohkado A, Ohnishi M, Kawasaki R, Nakane H
  • Organizer: International Meeting on Prisons and Health
  • Int'l Joint Research