Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
PLoS Negl Trop Dis. 2010 Feb 23;4(2):e610. doi: 10.1371/journal.pntd.0000610.
Symptoms and signs of leptospirosis are non-specific. Several diagnostic tests for leptospirosis are available and in some instances are being used prior to treatment of leptospirosis-suspected patients. There is therefore a need to evaluate the cost-effectiveness of the different treatment strategies in order to avoid misuse of scarce resources and ensure best possible health outcomes for patients.
The study population was adult patients, presented with uncomplicated acute febrile illness, without an obvious focus of infection or malaria or typical dengue infection. We compared the cost and effectiveness of 5 management strategies: 1) no patients tested or given antibiotic treatment; 2) all patients given empirical doxycycline treatment; patients given doxycycline when a patient is tested positive for leptospirosis using: 3) lateral flow; 4) MCAT; 5) latex test. The framework used is a cost-benefit analysis, accounting for all direct medical costs in diagnosing and treating patients suspected of leptospirosis. Outcomes are measured in length of fever after treatment which is then converted to productivity losses to capture the full economic costs.
Empirical doxycycline treatment was the most efficient strategy, being both the least costly alternative and the one that resulted in the shortest duration of fever. The limited sensitivity of all three diagnostic tests implied that their use to guide treatment was not cost-effective. The most influential parameter driving these results was the cost of treating patients with complications for patients who did not receive adequate treatment as a result of incorrect diagnosis or a strategy of no-antibiotic-treatment.
Clinicians should continue treating suspected cases of leptospirosis on an empirical basis. This conclusion holds true as long as policy makers are not prioritizing the reduction of use of antibiotics, in which case the use of the latex test would be the most efficient strategy.
钩端螺旋体病的症状和体征是非特异性的。有几种诊断钩端螺旋体病的方法，在某些情况下，在对疑似钩端螺旋体病患者进行治疗之前就已经使用了这些方法。因此，有必要评估不同治疗策略的成本效益，以避免滥用稀缺资源，并确保患者获得最佳的健康结果。
研究人群为患有无并发症的急性发热性疾病的成年患者，这些患者没有明显的感染灶、疟疾或典型的登革热感染。我们比较了 5 种管理策略的成本和效果：1）不检测或不给任何抗生素治疗；2）所有患者都给予经验性强力霉素治疗；3）当患者使用侧流法、MCAT 或乳胶试验检测出钩端螺旋体病时，给予强力霉素治疗；4）所有患者都给予强力霉素治疗。使用的框架是成本效益分析，考虑了所有直接医疗费用，用于诊断和治疗疑似钩端螺旋体病的患者。结果以治疗后发热的持续时间来衡量，然后转换为生产力损失，以捕捉全部经济成本。
经验性强力霉素治疗是最有效的策略，因为它是最具成本效益的选择，同时也是导致发热持续时间最短的策略。所有三种诊断测试的敏感性有限，这意味着它们用于指导治疗的成本效益不高。驱动这些结果的最具影响力的参数是治疗因诊断错误或不使用抗生素治疗策略而未得到充分治疗的患者并发症的成本。
临床医生应继续根据经验治疗疑似钩端螺旋体病病例。只要政策制定者不优先考虑减少抗生素的使用，这种结论就是正确的，在这种情况下，乳胶试验的使用将是最有效的策略。
