| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 103 === Background: Tuberculosis has been an important issue in infectious diseases control worldwide. The incidence and mortality rate have declined after the efforts of every countries and the international cooperation, but the decline trend is slowing down. "Find TB" and "Cure TB" are the 2 main strategies of TB control. Taiwan has been implemented chest X-ray screening for active case finding, especially for mountainous townships, since 1952. Although high-risk groups have a higher incidence, more than 95% of the patients are found in non-high-risk areas, e.g. non-mountainous communities by passive case finding. Objective: The purpose of this study is to evaluate the chest X-ray screening policy for active case finding in Taiwan. Method: We used spatial analysis and spatial autocorrelation analysis to examine where there was small area heterogeneity in TB distribution. This study also conducted cost-effectiveness analysis for chest X-ray screening in different TB incidence areas. Results: A total of 2,065 TB cases from 324 villages in Hualien and Taitung during 2009-2013 were included in this analysis. The heterogeneity of tuberculosis incidence was much easier to be detected by spatial analysis using village as the unit than using township as unit of analysis. The analysis also revealed that screening for lower TB incidence villages tended to have higher incremental cost-effectiveness ratio. Conclusion: This study suggests that using village as the unit for TB chest X-ray screening for active case finding is more appropriate than township. Moreover, this study recommends that villages with high TB incidence in non-mountainous area should be included in chest X-ray screening.
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