美国梅毒血清学检测：两种筛查算法的成本效益分析。

Serologic testing for syphilis in the United States: a cost-effectiveness analysis of two screening algorithms.

机构信息

Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-80, Atlanta, GA 30333, USA.

出版信息

Sex Transm Dis. 2011 Jan;38(1):1-7. doi: 10.1097/OLQ.0b013e3181ec51f1.

DOI:10.1097/OLQ.0b013e3181ec51f1

PMID:20739911

Abstract

BACKGROUND

The introduction of automated treponemal enzyme immunoassays and chemiluminescence assays (EIA/CA) tests has led some laboratories in the United States to use new syphilis screening algorithms that start with a treponemal test. We compared the economic and health outcomes of this new algorithm with the standard algorithm from the perspective of the United States health system.

METHODS

We used a cohort decision analysis to estimate the expected costs and effects (including follow-ups and overtreatment) of the 2 algorithms from a health-care system perspective. In the standard algorithm, rapid plasma reagin (RPR) is followed (if reactive) by EIA/CA (Nontreponemal-First). In the new algorithm, EIA/CA is followed (if reactive) by RPR. If the RPR is negative, Treponema pallidum passive particle agglutination assay (TP-PA) test is used (Treponemal-First).

RESULTS

For a cohort of 200,000 individuals (1000 current infections and 10,000 previous infections), the net costs were $1.6 m (Treponemal-First) and $1.4 m (Nontreponemal-First). The Treponemal-First option treated 118 more cases (986 vs. 868) but resulted in a substantially higher number of follow-ups (11,450 vs. 3756) and overtreatment (964 vs. 38). Treating the additional 118 cases might prevent 1 case of tertiary syphilis. The estimated cost-effectiveness ratios were $1671 (Treponemal-First) and $1621 (Nontreponemal-First) per case treated. The overtreatment was a function of the specificity of the EIA/CA and the lack of independence of EIA/CA and TP-PA.

CONCLUSION

The Treponemal-First option costs slightly more and results in more unnecessary treatment.

摘要

背景

自动化梅毒螺旋体酶免疫分析和化学发光检测（EIA/CA）试验的引入，导致美国一些实验室开始采用新的梅毒筛查算法，即从梅毒螺旋体检测开始。我们从美国卫生系统的角度比较了这种新算法与标准算法的经济和健康结果。

方法

我们使用队列决策分析从卫生保健系统的角度来估计这两种算法的预期成本和效果（包括随访和过度治疗）。在标准算法中，快速血浆反应素（RPR）（如果阳性）后接着进行 EIA/CA（非梅毒螺旋体试验优先）。在新算法中，EIA/CA（如果阳性）后接着进行 RPR。如果 RPR 为阴性，则使用梅毒螺旋体被动颗粒凝集试验（TP-PA）（梅毒螺旋体试验优先）。

结果

对于 20 万人的队列（1000 例现症感染和 10000 例既往感染），净成本分别为 160 万美元（梅毒螺旋体试验优先）和 140 万美元（非梅毒螺旋体试验优先）。梅毒螺旋体试验优先方案治疗了 118 例更多的病例（986 例与 868 例），但导致了大量更多的随访（11450 例与 3756 例）和过度治疗（964 例与 38 例）。治疗额外的 118 例可能会预防 1 例三期梅毒。估计的成本效益比分别为 1671 美元（梅毒螺旋体试验优先）和 1621 美元（非梅毒螺旋体试验优先）每例治疗。过度治疗是 EIA/CA 的特异性和 EIA/CA 与 TP-PA 缺乏独立性的函数。