King Charles H, Fischler Diana F, Gerkin Richard D
School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Clin Infect Dis. 2002 Jun 1;34(11):1491-9. doi: 10.1086/340341.
Cost-effectiveness analysis was done to evaluate the potential health and economic effects of a genetic screening program to identify individuals at risk for rheumatic fever (RF). The current RF prevention strategy was compared with a new, primary prevention strategy involving early genetic testing and intensive prophylaxis to prevent a first attack among individuals at high risk for RF. When analysis of a hypothetical 2000 birth cohort was done from a societal perspective, the prevention strategy involving genetic screening and prophylaxis for high-risk persons reduced the number of RF cases and increased life span at an estimated discounted cost of $7900 per quality-adjusted life-year gained. Genetic screening became the preferred (least expensive) strategy if the test specificity was >/=98%, the annual cost of prophylaxis was <$550, or the annual cost of caring for an individual with severe rheumatic heart disease increased to >$32,000. When used with available antibiotic prophylaxis, genetic testing has the potential to provide a cost-effective strategy for the primary prevention of RF and its sequelae.
进行了成本效益分析，以评估基因筛查项目对识别风湿热（RF）高危个体的潜在健康和经济影响。将当前的RF预防策略与一种新的一级预防策略进行了比较，新策略包括早期基因检测和强化预防措施，以预防RF高危个体首次发病。从社会角度对一个假设的2000名出生队列进行分析时，针对高危人群的基因筛查和预防策略减少了RF病例数量，并延长了寿命，每获得一个质量调整生命年的估计贴现成本为7900美元。如果检测特异性≥98%、预防的年度成本＜550美元，或照顾一名严重风湿性心脏病患者的年度成本增加到＞32000美元，基因筛查就会成为首选（成本最低）策略。当与现有的抗生素预防措施一起使用时，基因检测有可能为RF及其后遗症的一级预防提供一种具有成本效益的策略。
