Meier F A, Howland J, Johnson J, Poisson R
Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0433.
Arch Intern Med. 1990 Aug;150(8):1696-700.
Decision analysis and opinion survey suggest that introduction of rapid antigen detection tests should decrease the number of patients with negative test results for group A streptococcal pharyngitis treated by antibiotics. We reviewed all cases in which a test for group A streptococcal pharyngitis was performed during the last 7 months of culture diagnosis and the first 7 months of antigen test diagnosis at an inner city community health center, recording culture or antigen test results, whether antibiotics were prescribed, and patient status (as regular health center patients or patients referred to the center). Positive rates for culture and antigen-test periods were similar (10% and 12%), but 53% of patients with negative culture were treated, where only 32% of patients with negative antigen-test results received prescriptions. Significant reductions in the treatment of patients with negative test results were found in both patient-status subpopulations: health center patients, 43% to 29%; referred patients, 91% to 52%. Among health center patients reductions were consistent for both adult (30% to 21%) and child and adolescent (55% to 45%) age groups. For all patients with negative test results, direct costs of diagnostic reagents and antibiotic prescriptions fell from $3.58 per patient with culture to $3.45 with antigen testing; the $0.13 savings per patient was due to less treatment of referred patients. Thus, rapid antigen testing led to (1) significantly fewer patients with negative test results receiving antibiotic prescriptions; and, (2) savings in antibiotic costs offsetting reagent cost of antigen detection diagnosis.
决策分析和意见调查表明，引入快速抗原检测试验应能减少因A组链球菌性咽炎接受抗生素治疗但检测结果为阴性的患者数量。我们回顾了在内城区社区卫生中心进行A组链球菌性咽炎检测的所有病例，这些病例涵盖培养诊断的最后7个月以及抗原检测诊断的前7个月，记录培养或抗原检测结果、是否开具了抗生素处方以及患者状态（作为社区卫生中心的常规患者或转诊至该中心的患者）。培养期和抗原检测期的阳性率相似（分别为10%和12%），但培养结果为阴性的患者中有53%接受了治疗，而抗原检测结果为阴性的患者中只有32%收到了处方。在两个患者状态亚组中，检测结果为阴性的患者的治疗率均显著降低：社区卫生中心患者，从43%降至29%；转诊患者，从91%降至52%。在社区卫生中心患者中，成人（从30%降至21%）和儿童及青少年（从55%降至45%）年龄组的降低幅度均一致。对于所有检测结果为阴性的患者，诊断试剂和抗生素处方的直接成本从培养检测时的每位患者3.58美元降至抗原检测时的3.45美元；每位患者节省的0.13美元是由于转诊患者的治疗减少。因此，快速抗原检测导致（1）检测结果为阴性且接受抗生素处方的患者显著减少；以及（2）抗生素成本的节省抵消了抗原检测诊断的试剂成本。
