Fiddelers A A A, Land J A, Voss G, Kessels A G H, Severens J L
Department of Clinical Epidemiology and Medical Technology Assessment, Academisch Ziekenhuis Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Hum Reprod. 2005 Feb;20(2):425-32. doi: 10.1093/humrep/deh608. Epub 2004 Nov 11.
For the evaluation of tubal function, Chlamydia antibody testing (CAT) has been introduced as a screening test. We compared six CAT screening strategies (five CAT tests and one combination of tests), with respect to their cost-effectiveness, by using IVF pregnancy rate as outcome measure.
A decision analytic model was developed based on a source population of 1715 subfertile women. The model incorporates hysterosalpingography (HSG), laparoscopy and IVF. To calculate IVF pregnancy rates, costs, effects, cost-effectiveness and incremental costs per effect of the six different CAT screening strategies were determined.
pELISA Medac turned out to be the most cost-effective CAT screening strategy (15 075 per IVF pregnancy), followed by MIF Anilabsystems (15 108). A combination of tests (pELISA Medac and MIF Anilabsystems; 15 127) did not improve the cost-effectiveness of the single strategies. Sensitivity analyses showed that the results are robust for changes in the baseline values of the model parameters.
Only small differences were found between the screening strategies regarding the cost-effectiveness, although pELISA Medac was the most cost-effective strategy. Before introducing a particular CAT test into clinical practice, one should consider the effects and consequences of the entire screening strategy, instead of only the diagnostic accuracy of the test used.
为评估输卵管功能，衣原体抗体检测（CAT）已被用作一种筛查试验。我们以体外受精（IVF）妊娠率作为结局指标，比较了六种CAT筛查策略（五种CAT检测及一种检测组合）的成本效益。
基于1715名不孕妇女的源人群建立了一个决策分析模型。该模型纳入了子宫输卵管造影（HSG）、腹腔镜检查和IVF。为计算IVF妊娠率，确定了六种不同CAT筛查策略的成本、效果、成本效益及每效果的增量成本。
pELISA Medac被证明是最具成本效益的CAT筛查策略（每例IVF妊娠15075），其次是MIF Anilabsystems（15108）。检测组合（pELISA Medac和MIF Anilabsystems；15127）并未提高单一策略的成本效益。敏感性分析表明，模型参数基线值的变化对结果影响不大。
尽管pELISA Medac是最具成本效益的策略，但筛查策略在成本效益方面仅存在微小差异。在将特定的CAT检测引入临床实践之前，应考虑整个筛查策略的效果和后果，而不仅仅是所使用检测的诊断准确性。
