The main purpose of this paper is to demonstrate relevance of the medical technologyassessment (MTA) approach in the decision making process in the tuberculosis controlprogramme. Recently MTA has progressed remarkably under the pressure of limited medicalresources and necessity for rational utilization of those resources. This approach has alsobeen assisted by the development in related technologies, such as statistics and themanagerial sciences. The author demonstrates the feasibility of the MTA approach intuberculosis control programmes, with special emphasis on the applicability of themathematical model in risk-effectiveness analysis, citing several examples from his recentworks.A critical analysis of the screening chest radiophotography (Mass Miniature Radiophotography, MMR) is a good sample of risk-effectiveness analysis, where benefitfrom early detection of tuberculosis is quantified and compared with the possible risk dueto radiation exposure. A mathematical model is used to simulate the fate of tuberculosispatients with or without treatment. The benefit is computed in terms of lives saved, lifeyears extended, and treatment costs saved with or without the MMR programme. In Japan, it is concluded that MMR cannot be rationalized as a life-saving intervention in youngage-groups, nor being economically cost-effective for wider age ranges.
Based on the estimated trend of risk of infection of Japan now and in the near future, the infection status of a cohort born around 1990 can be calculated. Applying risk of clinicalbreakdown of tuberculosis to the above infection status and the assumed level of protectiveefficacy of BCG vaccination, assessment of the BCG vaccination programme can be made, under various hypothetical modes of vaccination, whether vaccinated to the newborn or toschool entrants, whether revaccinated or not, and when, etc. The analysis revealed that therevaccination has very limited effectiveness, which in turn emphasizes the importance of theprimary vaccination with optimum technical level.
