Campbell J R, Paris M, Schaffer S J
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY, USA.
Arch Pediatr Adolesc Med. 1996 Nov;150(11):1205-8. doi: 10.1001/archpedi.1996.02170360095016.
To calculate and compare the average expected cost per child screened (hereafter referred to as COST) among various screening strategies.
A decision analysis of 5 strategies: (1) conduct risk assessment and screen high-risk children by venipuncture, low-risk children by fingerstick; (2) screen all children by fingerstick; (3) screen all children by venipuncture; (4) conduct risk assessment, screen high-risk children by fingerstick; and (5) conduct risk assessment, screen high-risk children by venipuncture. We assumed all fingerstick blood lead levels of 0.72 mumol/L or higher (> or = 15 micrograms/dL) would be confirmed by venipuncture. Baseline variables taken from the literature included prevalence of elevated blood lead levels in the pediatric population (2%), sensitivity and specificity of fingerstick blood lead assay (90% each), specificity of risk assessment (50%), sensitivity of risk assessment at blood lead levels of 0.48 to 0.68 mumol/L (10-14 micrograms/dL) and 0.72 mumol/L or higher (> or = 15 micrograms/dL) (65% and 85%, respectively), cost of blood lead assay ($6), cost to obtain blood by venipuncture ($4) and fingerstick ($2), and cost to get a child who has a fingerstick blood lead level of 0.72 mumol/L or higher (> or = 15 micrograms/dL) to return ($0.18). Sensitivity analysis determined whether selected variables affected the COST.
The COSTs for strategies 1 through 5 were $9.07, $8.16, $10, $4.13, and $5.04, respectively. Among the universal strategies, screening children by fingerstick had the lowest COST at a prevalence of less than 38% and fingerstick blood lead assay a specificity of greater than 62%. Among the selective strategies, screening high-risk children by fingerstick had the lowest COST at a prevalence of less than 38% and fingerstick blood lead an assay specificity of greater than 63%.
At a readily attainable specificity of the fingerstick blood lead assay, practices serving a patient population with a prevalence of elevated blood lead levels of less than 38% will have the lowest COST when a fingerstick screening strategy is used.
计算并比较不同筛查策略下每名接受筛查儿童的平均预期成本（以下简称成本）。
对5种策略进行决策分析：（1）进行风险评估，对高危儿童采用静脉穿刺采血筛查，对低危儿童采用指尖采血筛查；（2）对所有儿童采用指尖采血筛查；（3）对所有儿童采用静脉穿刺采血筛查；（4）进行风险评估，对高危儿童采用指尖采血筛查；（5）进行风险评估，对高危儿童采用静脉穿刺采血筛查。我们假设所有指尖血铅水平为0.72 μmol/L或更高（≥15 μg/dL）的情况都将通过静脉穿刺采血进行确认。从文献中获取的基线变量包括儿科人群血铅水平升高的患病率（2%）、指尖血铅检测的灵敏度和特异度（均为90%）、风险评估的特异度（50%）、血铅水平在0.48至0.68 μmol/L（10 - 14 μg/dL）和0.72 μmol/L或更高（≥15 μg/dL）时风险评估的灵敏度（分别为65%和85%）、血铅检测成本（6美元）、静脉穿刺采血成本（4美元）和指尖采血成本（2美元），以及让指尖血铅水平为0.72 μmol/L或更高（≥15 μg/dL）的儿童回来复查的成本（0.18美元）。灵敏度分析确定所选变量是否会影响成本。
策略1至5的成本分别为9.07美元、8.16美元、10美元、4.13美元和5.04美元。在通用策略中，当患病率低于38%且指尖血铅检测特异度大于62%时，采用指尖采血筛查儿童的成本最低。在选择性策略中，当患病率低于38%且指尖血铅检测特异度大于63%时，采用指尖采血筛查高危儿童的成本最低。
在指尖血铅检测特异度易于达到的情况下，对于血铅水平升高患病率低于38%的患者群体，采用指尖采血筛查策略时成本最低。
