Rajalahti I, Ruokonen E L, Kotomäki T, Sintonen H, Nieminen M M
Dept of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland.
Eur Respir J. 2004 Mar;23(3):446-51. doi: 10.1183/09031936.04.00009704.
To determine whether polymerase chain reaction (PCR) testing in the initial diagnosis of pulmonary tuberculosis (TB) is cost-effective in a low-prevalence population, an economic evaluation was carried out between the smear and culture (NOPCR) and smear, culture and PCR (+PCR) strategies. A decision tree model based on retrospective laboratory data was developed to assess the strategies of testing patients with suspicion of TB. Direct healthcare costs prior to confirmation of TB or nontuberculous mycobacteria by PCR or culture were included. Effectiveness was measured by the probability of correct treatment and isolation decisions. In the baseline situation NOPCR costs Euro 29.50 less than the +PCR strategy per patient tested. According to sensitivity analyses, reducing PCR test price, shortening test performance time or increasing the proportion of smear-positive patients in the tested population would contribute to cost savings with the +PCR strategy. Routine polymerase chain reaction testing of all specimens from suspected tuberculosis patients in a low-prevalence population was not cost-saving. When the polymerase chain reaction assay was applied only to smear-positive sputum specimens, the smear and culture strategy was clearly dominated by it, i.e. the polymerase chain reaction smear-positive sputum strategy was less costly and more effective in producing correct treatment decisions and isolations.
为确定在低发病率人群中，聚合酶链反应（PCR）检测用于肺结核（TB）的初始诊断是否具有成本效益，我们对涂片和培养（无PCR）以及涂片、培养和PCR（有PCR）策略进行了经济学评估。基于回顾性实验室数据建立了决策树模型，以评估对疑似结核病患者进行检测的策略。纳入了在通过PCR或培养确认结核病或非结核分枝杆菌之前的直接医疗费用。通过正确治疗和隔离决策的概率来衡量有效性。在基线情况下，无PCR策略对每位受检患者的成本比有PCR策略低29.50欧元。根据敏感性分析，降低PCR检测价格、缩短检测执行时间或增加受检人群中涂片阳性患者的比例，将有助于采用有PCR策略节省成本。在低发病率人群中，对所有疑似结核病患者的标本进行常规聚合酶链反应检测并不节省成本。当聚合酶链反应检测仅应用于涂片阳性的痰标本时，涂片和培养策略显然被其主导，即聚合酶链反应涂片阳性痰标本策略成本更低，在做出正确治疗决策和隔离方面更有效。
