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微生物无细胞 DNA 检测(Karius 检测)用于疑似侵袭性真菌感染的免疫功能低下患者替代有创性检查的预算影响。

Budget Impact of Microbial Cell-Free DNA Testing Using the Karius Test as an Alternative to Invasive Procedures in Immunocompromised Patients with Suspected Invasive Fungal Infections.

机构信息

Karius, Inc., 975 Island Drive, Suite 101, Redwood City, CA, 94065, USA.

ICON Plc, Marlow, UK.

出版信息

Appl Health Econ Health Policy. 2021 Mar;19(2):231-241. doi: 10.1007/s40258-020-00611-7. Epub 2020 Sep 17.

Abstract

BACKGROUND

Invasive fungal infection is a major source of morbidity and mortality. The usage of microbial cell-free DNA for the detection and identification of invasive fungal infection has been considered as a potential alternative to invasive procedures allowing for rapid results.

OBJECTIVE

This analysis aimed to assess the budget implications of using the Karius Test in patients suspected of invasive fungal infection in an average state in the USA from a healthcare payer perspective.

METHODS

The analysis used a decision tree to capture key stages of the patient pathway, from suspected invasive fungal infection to either receiving treatment for invasive fungal infection or being confirmed as having no invasive fungal infection. The analysis used published costs and resource use from a targeted review of the literature. Because of the paucity of published evidence on the reduction of diagnostic tests displaced by the Karius Test, the analysis used a 50% reduction in the use of bronchoscopy and/or bronchoalveolar lavage. The impact of this reduction was tested in a scenario analysis.

RESULTS

The results of the analysis show that the introduction of the Karius Test is associated with a cost saving of US$2277 per patient; when multiplied by the estimated number of cases per year, the cost saving is US$17,039,666. The scenario analysis showed that the Karius Test only had an incremental cost of US$87 per patient when there was no reduction in bronchoscopy and bronchoalveolar lavage.

CONCLUSIONS

The Karius Test may offer a valuable and timely option for the diagnosis of invasive fungal infection through its non-invasive approach and subsequent cost savings.

摘要

背景

侵袭性真菌感染是发病率和死亡率的主要来源。微生物无细胞 DNA 的使用,因其能够快速提供结果,被认为是侵袭性程序的潜在替代方法,用于检测和鉴定侵袭性真菌感染。

目的

本分析旨在从医疗保健支付者的角度评估在美国一个平均州,疑似侵袭性真菌感染的患者使用卡里乌斯检测的预算影响。

方法

该分析使用决策树来捕获患者路径的关键阶段,从疑似侵袭性真菌感染到接受侵袭性真菌感染治疗或被确认为无侵袭性真菌感染。该分析使用了针对文献的目标审查中公布的成本和资源使用情况。由于缺乏关于被卡里乌斯检测取代的诊断检测减少的已发表证据,该分析使用支气管镜检查和/或支气管肺泡灌洗减少 50%。在情景分析中测试了这种减少的影响。

结果

分析结果表明,引入卡里乌斯检测可使每位患者的成本节省 2277 美元;乘以每年估计的病例数,节省成本为 17039666 美元。情景分析表明,当支气管镜检查和支气管肺泡灌洗没有减少时,卡里乌斯检测的每位患者的增量成本仅为 87 美元。

结论

卡里乌斯检测通过其非侵入性方法和随后的成本节约,可能为侵袭性真菌感染的诊断提供有价值且及时的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/78fb/7902590/a056dd9e8821/40258_2020_611_Fig1_HTML.jpg

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