2014-01-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/656462摘要：結核病防治一直是台灣公共衛生的重要問題，疾病管制局在2006 年開始了十年減半計畫，雖然在前幾年結核病的通報率持續下降，但是在近兩年來通報率的下降卻逐漸趨緩。為了要使通報率的下降能夠繼續維持，除了現有的被動個案發現與治療之外，有關單位需要擬定新的結核病防治策略。可能的新的結核病防治介入方式包括高危險群與接觸者的主動個案發現以及潛伏感染個案的診斷與治療，但這些新的介入方式也不是完全沒有風險，例如潛伏感染的治療可能會帶來肝毒性的副作用，因此，在政策制定上，需要有一較完整的研究評估來讓相關單位了解不同介入可能帶來的效益與危害，尤其，在有限的傳染病防治經費之下，需要對於不同介入的成本效益作一深入探討。本研究試圖評估不同的結核病防治策略可能帶來的影響，以及探討結核病相關的危險因子的趨勢變化又將如何影響未來的結核病防治。我們將建立一個結核病動態傳播的數理模型，並將之調整到能代表台灣過去及目前之結核病疫情狀態，然後利用此一數理模型來評估不同結核病介入政策可能帶來的疫情影響。同時，我們亦將深入了解不同介入可能導致的相關成本與花費，以進行較完整的成本效益分析。最後，我們將針對不同的結核病危險因子(吸菸，糖尿病，飲酒等)建立個別的動態模型，以了解這些危險因子的變化將如何影響結核病趨勢。本研究將提供當前結核病防治單位在制定政策時可供參考的重要實證依據，並且將是結核病的中度疫情國家中，少數完整的政策評估與成本效益分析。結核病中度疫情國家的結核病防治與高疫情及低疫情國家的情形不同，因此需要不同的思維方式。本研究結果將對其他中度疫情國家(例如許多東南亞國家與中南美洲國家)未來的結核病防治與政策制定過程，預期將產生重大影響。<br> Abstract: Although substantial reduction in tuberculosis notification rate was observed in the past decade, thedecline has slowed down in the past two years. To further bring down tuberculosis epidemic in Taiwan,additional strategies for tuberculosis control and prevention will likely be needed. Policy makers in Taiwan are now faced with the challenge of choosing the appropriate intervention strategies to complement passive case finding and to improve tuberculosis control. The decision needs to be made considering the likely benefits and harms of each potential intervention, while working under the constraint of limited budget. To assist and guide policy making, we propose to comprehensively evaluate the potential impacts of several tuberculosis control measures and modifiable risk factors. We will develop an epidemic model of TB transmission to assess the potential impact of TB control measures in Taiwan. We will then conduct a cost-effectiveness analysis to compare and prioritize several TB intervention strategies. Lastly, we will model the potential influence of changes of modifiable risk factors on future trend of TB epidemiology. We expect the results of our research will provide critical information on potential impacts of major control interventions that are currently being considered by policy makers and will add to the evidence base of tuberculosis control policies in Taiwan. Our research will also be one of the very few studies to evaluate tuberculosis control policy in a middle-to-high income country, and the results will be of interest to other countries with a similar tuberculosis situation and tothe countries that are in a transition from high incidence to middle and low incidence situation.成本效益分析