Hueston William J, Benich Joseph J
Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Ann Fam Med. 2004 Jan-Feb;2(1):33-40. doi: 10.1370/afm.34.
Clinical diagnosis and empiric therapy have been strategies for treatment of suspected influenza in high-risk patients, but rapid tests for influenza have been introduced to help confirm cases. The aim of this study was to determine when rapid testing, empiric treatment, or no treatment is most cost-beneficial for high-risk adults with influenzalike respiratory tract illnesses.
We performed a cost-benefit analysis evaluating the comparative advantage of the strategies of empiric therapy, no treatment, or test and treat patients whose tests are positive. The analysis focused on a hypothetical population of patients who are at a high-risk for complications of influenza. Our main outcome was the cost of care for an episode of influenza taken from the human capital perspective.
For older anti-influenza drugs (amantadine and rimantadine), rapid testing is not as cost-beneficial as empiric treatment, even when the prevalence of influenza is low. For the neuraminidase inhibitors, there is a narrow window of disease prevalence between 30% and 40% where testing is most cost-beneficial. When the disease likelihood is above this window, empiric treatment is preferred. Below this window, no treatment is more cost-beneficial. Even under the most favorable conditions, testing is preferred only for a small range of prevalence rates of influenza.
When clinicians are planning to use the nonneuraminidase inhibitors to treat influenza, rapid testing is not the most cost-beneficial approach. Even when the more expensive neuraminidase inhibitors will be used, testing has a limited role in managing influenza in high-risk patients.
临床诊断和经验性治疗一直是高危患者疑似流感治疗的策略，但现已引入流感快速检测以帮助确诊病例。本研究的目的是确定对于患有流感样呼吸道疾病的高危成年人，何时进行快速检测、经验性治疗或不治疗最具成本效益。
我们进行了一项成本效益分析，评估经验性治疗、不治疗或对检测呈阳性患者进行检测并治疗策略的比较优势。该分析聚焦于一组假设的流感并发症高危患者群体。我们的主要结局是从人力资本角度计算的一次流感发作的护理成本。
对于较老的抗流感药物（金刚烷胺和金刚乙胺），即使流感患病率较低，快速检测的成本效益也不如经验性治疗。对于神经氨酸酶抑制剂，在疾病患病率介于30%至40%之间时有一个狭窄的窗口，此时检测的成本效益最高。当疾病可能性高于此窗口时，首选经验性治疗。低于此窗口时，不治疗的成本效益更高。即使在最有利的条件下，仅在一小范围的流感患病率时检测才是首选。
当临床医生计划使用非神经氨酸酶抑制剂治疗流感时，快速检测并非最具成本效益的方法。即使使用更昂贵的神经氨酸酶抑制剂，检测在高危患者流感管理中的作用也有限。
