Nishijima Daniel K, Yang Zhuo, Newgard Craig D
Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, United States of America.
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
Am J Emerg Med. 2021 Dec;50:492-500. doi: 10.1016/j.ajem.2021.08.037. Epub 2021 Aug 20.
A pediatric field triage strategy that meets the national policy benchmark of ≥95% sensitivity would likely improve health outcomes but increase heath care costs. Our objective was to compare the cost-effectiveness of current pediatric field triage practices to an alternative field triage strategy that meets the national policy benchmark of ≥95% sensitivity.
We developed a decision-analysis Markov model to compare the outcomes and costs of the two strategies. We used a prospectively collected cohort of 3507 (probability weighted, unweighted n = 2832) injured children transported by 44 emergency medical services (EMS) agencies to 28 trauma and non-trauma centers in the Northwestern United States from 1/1/2011 to 12/31/2011 to derive the alternative field triage strategy and to populate model probability and cost inputs for both strategies. We compared the two strategies by calculating quality adjusted life years (QALYs) and health care costs over a time horizon from the time of injury until death. We set an incremental cost-effectiveness ratio threshold of less than $100,000 per QALY for the alternative field triage to be a cost-effective strategy.
Current pediatric field triage practices had a sensitivity of 87.4% (95% confidence interval [CI] 71.9 to 95.0%) and a specificity of 82.3% (95% CI 81.0 to 83.5%) and the alternative field triage strategy had a sensitivity of 97.3% (95% CI 82.6 to 99.6%) and a specificity of 46.1% (95% CI 43.8 to 48.4%). The alternative field triage strategy would cost $476,396 per QALY gained compared to current pediatric field triage practices and thus would not be a cost-effective strategy. Sensitivity analyses demonstrated similar findings.
Current field triage practices do not meet national policy benchmarks for sensitivity. However, an alternative field triage strategy that meets the national policy benchmark of ≥95% sensitivity is not a cost-effective strategy.
一种符合国家政策基准（灵敏度≥95%）的儿科现场分诊策略可能会改善健康结局，但会增加医疗保健成本。我们的目标是比较当前儿科现场分诊实践与一种符合国家政策基准（灵敏度≥95%）的替代现场分诊策略的成本效益。
我们开发了一个决策分析马尔可夫模型，以比较两种策略的结局和成本。我们使用了一个前瞻性收集的队列，该队列包含3507名（概率加权，未加权n = 2832）受伤儿童，这些儿童由44个紧急医疗服务（EMS）机构于2011年1月1日至2011年12月31日转运至美国西北部的28个创伤和非创伤中心，以得出替代现场分诊策略，并为两种策略填充模型概率和成本输入。我们通过计算从受伤到死亡期间的质量调整生命年（QALY）和医疗保健成本来比较这两种策略。我们将替代现场分诊的增量成本效益比阈值设定为每QALY低于100,000美元，以使其成为具有成本效益的策略。
当前儿科现场分诊实践的灵敏度为87.4%（95%置信区间[CI] 71.9至95.0%），特异度为82.3%（95% CI 81.0至83.5%），替代现场分诊策略的灵敏度为97.3%（95% CI 82.6至99.6%），特异度为46.1%（95% CI 43.8至48.4%）。与当前儿科现场分诊实践相比，替代现场分诊策略每获得一个QALY将花费476,396美元，因此不是一种具有成本效益的策略。敏感性分析显示了类似的结果。
当前的现场分诊实践不符合国家政策的灵敏度基准。然而一种符合国家政策基准（灵敏度≥95%）的替代现场分诊策略不是一种具有成本效益的策略。
