{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:35:07Z","timestamp":1789662907653,"version":"4.0.1"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1696952","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T06:37:24Z","timestamp":1767595044000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness analysis of tuberculosis screening in diabetic patients in China: a decision-analytic Markov 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