Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.
Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada.
PLoS One. 2020 Nov 16;15(11):e0242255. doi: 10.1371/journal.pone.0242255. eCollection 2020.
Our objective was to assess the cost-effectiveness of novel rapid diagnostic tests: rapid influenza diagnostic tests (RIDT), digital immunoassays (DIA), rapid nucleic acid amplification tests (NAAT), and other treatment algorithms for influenza in high-risk patients presenting to hospital with influenza-like illness (ILI).
We developed a decision-analytic model to assess the cost-effectiveness of diagnostic test strategies (RIDT, DIA, NAAT, clinical judgement, batch polymerase chain reaction) preceding treatment; no diagnostic testing and treating everyone; and not treating anyone. We modeled high-risk 65-year old patients from a health payer perspective and accrued outcomes over a patient's lifetime. We reported health outcomes, quality-adjusted life years (QALYs), healthcare costs, and net health benefit (NHB) to measure cost-effectiveness per cohort of 100,000 patients.
Treating everyone with no prior testing was the most cost-effective strategy, at a cost-effectiveness threshold of $50,000/QALY, in over 85% of simulations. This strategy yielded the highest NHB of 15.0344 QALYs, but inappropriately treats all patients without influenza. Of the novel rapid diagnostics, NAAT resulted in the highest NHB (15.0277 QALYs), and the least number of deaths (1,571 per 100,000). Sensitivity analyses determined that results were most impacted by the pretest probability of ILI being influenza, diagnostic test sensitivity, and treatment effectiveness.
Based on our model, treating high-risk patients presenting to hospital with influenza-like illness, without performing a novel rapid diagnostic test, resulted in the highest NHB and was most cost-effective. However, consideration of whether treatment is appropriate in the absence of diagnostic confirmation should be taken into account for decision-making by clinicians and policymakers.
本研究旨在评估新型快速诊断检测方法（RIDT、DIA、NAAT 和其他流感治疗方案）在因流感样疾病（ILI）就诊的高危患者中的成本效益。
我们开发了一种决策分析模型，以评估治疗前诊断测试策略（RIDT、DIA、NAAT、临床判断、批量聚合酶链反应）、不进行任何诊断检测而治疗所有患者、不治疗任何患者的成本效益。我们以卫生支付者的角度为 65 岁以上的高危患者建模，并在患者的一生中累计结果。我们报告了健康结果、质量调整生命年（QALY）、医疗保健成本和净健康效益（NHB），以衡量每 10 万患者队列的成本效益。
在超过 85%的模拟中，不进行任何先前检测而治疗所有患者的策略是最具成本效益的策略，其成本效益阈值为 50,000 美元/QALY。该策略产生了最高的 NHB（15.0344 QALY），但不恰当地治疗了所有没有流感的患者。在新型快速诊断中，NAAT 产生了最高的 NHB（15.0277 QALY）和最少的死亡人数（每 10 万人中有 1571 人死亡）。敏感性分析表明，结果受 ILI 为流感的先验概率、诊断检测敏感性和治疗效果的影响最大。
根据我们的模型，对于因流感样疾病就诊的高危患者，不进行新型快速诊断检测而进行治疗，可获得最高的 NHB，并且最具成本效益。然而，在没有诊断确认的情况下，是否进行治疗应该被考虑在内，以便临床医生和决策者做出决策。
