Herráez Óscar, Asencio-Egea María Ángeles, Huertas-Vaquero María, Carranza-González Rafael, Castellanos-Monedero Jesús, Franco-Huerta María, Barberá-Farré José Ramón, Tenías-Burillo José María
Laboratorio de Análisis Clínicos, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
Laboratorio de Microbiología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
Enferm Infecc Microbiol Clin. 2017 Aug-Sep;35(7):403-410. doi: 10.1016/j.eimc.2016.06.009. Epub 2016 Jul 18.
INTRODUCTION/OBJECTIVE: To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative.
A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity.
A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital.
The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital.
引言/目的：对一种用于诊断结核病的分子生物学技术与传统诊断方法进行成本效益分析。
进行成本效益分析，以评估一种分子生物学方法的理论实施情况，该方法包括两种用于早期检测结核分枝杆菌复合群及利福平耐药性的替代技术（替代方案1：对选定患者进行一次检测；替代方案2：对所有患者进行两次检测）。将这两种替代方案与结核病微生物诊断的常规程序（染色和微生物培养）进行比较，并在2008 - 2012年期间对1972例患者进行分析。效益以质量调整生命年（QALYs）衡量，不确定性通过单变量、多变量和概率敏感性分析进行评估。
常规方法获得的成本效益值为每质量调整生命年8588欧元。替代方案1的总支出为每质量调整生命年8487欧元，而替代方案2的成本效益比为每质量调整生命年2960欧元。应用替代方案2观察到更高的诊断效率，结核病患者未得到适当治疗的天数减少了75%，非结核病患者住院天数减少了70%。
与常规方法相比，在结核病诊断中实施分子微生物技术具有极高的成本效益。将其引入常规诊断程序可改善患者的护理质量，因为这既能避免不必要的住院和治疗，又能为医院节省经济成本。
