McNeil B J, Thompson M, Adelstein S J
Eur J Nucl Med. 1980 Jun;5(3):271-6. doi: 10.1007/BF00271911.
This study illustrates how cost-effectiveness calculations provide help in decisions involving a choice between introduction of a new diagnostic procedure or a new therapy for a particular clinical problem. This type of problem is critical for areas where financial resources are limiting. Our analysis is centered on the value of diagnosis and treatment in tuberculous meningitis (Tbm) and, because of its importance to developing countries, our epidemiologic data were derived from India. When financial costs are ignored, the introduction of second line therapy (e.g., Rifampin) leads to more cures than does the introduction of even a perfect diagnostic test. However, diagnostic tests (e.g., the Bromide partition test or possibly radioassays) markedly improve case finding and to some extent increase cure rates. All affects vary markedly with the prevalence of tuberculous meningitis in the population under study. For example, net financial savings would occur were a perfect nuclear test available and conventional therapy used at a prevalence of Tbm of 30% whereas there would be a net loss if the prevalence rose to 80%. This study underscores the need for detailed studies on the radiobromide partition test and for the development of new diagnostic tests, perhaps a radioimmunoassay of either the acid fast bacillus or of an antibody to it.
本研究说明了成本效益计算如何有助于做出决策，这些决策涉及在引入针对特定临床问题的新诊断程序或新疗法之间进行选择。对于资金资源有限的领域，这类问题至关重要。我们的分析集中在结核性脑膜炎（Tbm）诊断和治疗的价值上，并且由于其对发展中国家的重要性，我们的流行病学数据来自印度。若忽略财务成本，引入二线治疗（如利福平）比引入哪怕是完美的诊断测试能带来更多治愈病例。然而，诊断测试（如溴化物分配试验或可能的放射分析）能显著改善病例发现情况，并在一定程度上提高治愈率。所有这些影响因所研究人群中结核性脑膜炎的患病率不同而有显著差异。例如，若有完美的核试验且在结核性脑膜炎患病率为30%时使用传统疗法，会实现净财务节省；而如果患病率升至80%，则会出现净损失。本研究强调了对放射性溴化物分配试验进行详细研究以及开发新诊断测试的必要性，或许可以是针对抗酸杆菌或其抗体的放射免疫测定。
