Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 01605, USA.
Sex Transm Infect. 2013 Mar;89(2):108-14. doi: 10.1136/sextrans-2011-050355. Epub 2012 Sep 14.
To compare the effectiveness and cost-effectiveness of a promising new point-of-care (POC) chlamydia test with traditional nucleic acid amplification testing (NAAT), and to determine the characteristics that would make a POC test most cost-effective.
A decision tree was constructed to model chlamydia screening visits to a sexually transmitted disease clinic by a hypothetical cohort of 10,000 women. The model incorporated programmatic screening costs, treatment costs and medical costs averted through prevention of pelvic inflammatory disease (PID) and its sequelae. Parameter values and costs were estimated for each node in the decision tree based on primary data, published data and unpublished health data.
For the base-case scenario (POC sensitivity 92.9%; 47.5% of women willing to wait 40 min for test results; test cost $33.48), POC was estimated to save US$5050 for each case of PID averted compared with NAAT. One-way sensitivity analyses indicated that POC would dominate NAAT if the POC test cost is <US$41.52 or if POC sensitivity is ≥ 87.1%. In a probabilistic sensitivity analysis (Monte Carlo simulations, 10 000 iterations), 10.8% of iterations indicated that the POC strategy dominated the NAAT strategy. The mean incremental cost-effectiveness ratio indicated that the POC strategy would save US$28 in total, and avert 14 PID cases.
A promising new chlamydia POC test is likely to be cost-effective compared with traditional NAAT. The POC test sensitivity, cost and proportion of women willing to wait for the POC test result are key elements to determining the cost-effectiveness of any new POC test strategy.
比较一种有前途的新型即时检测（POC）沙眼衣原体检测与传统核酸扩增检测（NAAT）的有效性和成本效益，并确定使 POC 检测最具成本效益的特征。
构建决策树模型，以模拟一个由 10000 名女性组成的假设队列的性传播疾病诊所进行沙眼衣原体筛查。该模型纳入了程序筛查成本、治疗成本以及通过预防盆腔炎（PID）及其后遗症而避免的医疗成本。根据原始数据、已发表数据和未发表的健康数据，为决策树中的每个节点估算参数值和成本。
在基本情况下（POC 敏感性为 92.9%；47.5%的女性愿意等待 40 分钟获得检测结果；检测费用为 33.48 美元），与 NAAT 相比，POC 可估计为每例 PID 节省 5050 美元。单因素敏感性分析表明，如果 POC 检测费用<41.52 美元或 POC 敏感性≥87.1%，则 POC 将优于 NAAT。在概率敏感性分析（蒙特卡罗模拟，10000 次迭代）中，有 10.8%的迭代表明 POC 策略优于 NAAT 策略。平均增量成本效益比表明，POC 策略总共可节省 28 美元，并避免 14 例 PID。
与传统的 NAAT 相比，一种有前途的新型沙眼衣原体 POC 检测可能具有成本效益。POC 检测的敏感性、成本以及愿意等待 POC 检测结果的女性比例是确定任何新的 POC 检测策略成本效益的关键因素。
