Rouse D J, Andrews W W, Goldenberg R L, Owen J
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA.
Obstet Gynecol. 1995 Jul;86(1):119-23. doi: 10.1016/0029-7844(95)00097-B.
To compare the effectiveness, benefits, and costs of two asymptomatic bacteriuria screening and treatment strategies to prevent pyelonephritis in pregnancy.
A decision analytic model was created to compare strategies based on either 1) a leukocyte esterase-nitrite dipstick, or 2) on urine culture, with a policy of no screening or treatment. A literature search was conducted to generate probability estimates. Cost estimates were based on a local pharmacy and laboratory survey and supplemented by recent literature estimates. Sensitivity analyses were performed over wide ranges of probability and cost estimates.
Under baseline assumptions, no screening resulted in 23.2 cases of pyelonephritis per 1000 pregnancies, versus 16.2 cases with the dipstick strategy and 11.2 with the culture strategy. The cost of screening and treatment of asymptomatic bacteriuria per 1000 pregnancies was $1968 with dipstick and $19,264 with culture. The cost of treating pyelonephritis with no screening was $57,562, versus $40,257 with dipstick and $27,832 with culture. Therefore, both the dipstick strategy and the culture strategy were cost-beneficial (based on a pyelonephritis cost of $2485) when compared with no screening. However, because it cost $3492 to prevent each additional case of pyelonephritis with culture that was not prevented by dipstick, the culture strategy was not cost-beneficial compared with the dipstick strategy. These results were sensitive to varying estimates for the prevalence of asymptomatic bacteriuria, the rate of progression of asymptomatic bacteriuria to pyelonephritis, the sensitivity of the dipstick, culture costs, and the cost of a case of pyelonephritis.
When compared with a policy of no screening, screening for and treatment of asymptomatic bacteriuria to prevent pyelonephritis in pregnancy is cost-beneficial whether based on the leukocyte esterase-nitrite dipstick or on urine culture. However, the culture strategy is not cost-beneficial when compared with the dipstick strategy.
比较两种无症状菌尿筛查及治疗策略预防妊娠期肾盂肾炎的有效性、益处和成本。
建立决策分析模型，比较基于以下两种策略：1）白细胞酯酶-亚硝酸盐试纸条法，或2）尿培养法，与不进行筛查或治疗的策略。通过文献检索得出概率估计值。成本估计基于当地药房和实验室调查，并辅以近期文献估计值。在广泛的概率和成本估计范围内进行敏感性分析。
在基线假设下，不进行筛查每1000例妊娠中有23.2例肾盂肾炎，而试纸条法策略为16.2例，培养法策略为11.2例。每1000例妊娠无症状菌尿的筛查和治疗成本，试纸条法为1968美元，培养法为19264美元。不进行筛查治疗肾盂肾炎的成本为57562美元，试纸条法为40257美元，培养法为27832美元。因此，与不进行筛查相比，试纸条法策略和培养法策略均具有成本效益（基于肾盂肾炎成本为2485美元）。然而，由于培养法预防每例额外肾盂肾炎病例的成本比试纸条法多3492美元，与试纸条法策略相比，培养法策略不具有成本效益。这些结果对无症状菌尿患病率、无症状菌尿进展为肾盂肾炎的发生率、试纸条法的敏感性、培养成本以及一例肾盂肾炎的成本等不同估计值敏感。
与不进行筛查的策略相比，无论是基于白细胞酯酶-亚硝酸盐试纸条法还是尿培养法，筛查和治疗无症状菌尿以预防妊娠期肾盂肾炎均具有成本效益。然而，与试纸条法策略相比，培养法策略不具有成本效益。
