Kemper A R, Bordley W C, Downs S M
Children's Primary Care Research Group, Department of Pediatrics, University of North Carolina, Chapel Hill 27599-7225, USA.
Arch Pediatr Adolesc Med. 1998 Dec;152(12):1202-8. doi: 10.1001/archpedi.152.12.1202.
To compare blood lead (BPb) poisoning screening strategies in light of the 1997 recommendations by the Centers for Disease Control and Prevention, Atlanta, Ga.
Cost-effectiveness analysis from the perspective of the health care system to compare the following 4 screening strategies: (1) universal screening of venous BPb levels; (2) universal screening of capillary BPb levels; (3) targeted screening of venous BPb levels for those at risk; and (4) targeted screening of capillary BPb levels for those at risk. Costs of follow-up testing and treatment were included in the model.
Only universal venous screening detected all BPb levels of at least 0.48 micromol/L (10 microg/dL). Universal capillary screening detected between 93.2% and 95.5% of cases, depending on the prevalence of elevated BPb levels. Targeted screening was the least sensitive strategy for detecting cases. Venous testing identified between 77.3% and 77.9% of cases, and capillary testing detected between 72.7% and 72.8% of cases. In high-prevalence populations, universal venous screening minimized the cost per case ($490). In low- and medium-prevalence populations, targeted screening using venous testing minimized the cost per case ($729 and $556, respectively). In all populations, regardless of screening strategy, venous testing resulted in a lower cost per case than capillary testing. Sensitivity analyses of all parameters in this model demonstrated that this conclusion is robust.
Universal screening detects all cases of lead poisoning and is the most cost-effective strategy in high-prevalence populations. In populations with lower prevalence, the cost per case detected using targeted screening is less than that of universal screening. The benefit of detecting a greater number of cases using universal screening must be weighed against the extra cost of screening. Regardless of whether a strategy of universal or targeted screening is used, the cost per case using venous testing is less than that of capillary testing.
根据佐治亚州亚特兰大市疾病控制与预防中心1997年的建议，比较血铅（BPb）中毒筛查策略。
从医疗保健系统的角度进行成本效益分析，以比较以下4种筛查策略：（1）对静脉血BPb水平进行普遍筛查；（2）对毛细血管血BPb水平进行普遍筛查；（3）对有风险人群的静脉血BPb水平进行针对性筛查；（4）对有风险人群的毛细血管血BPb水平进行针对性筛查。模型中纳入了后续检测和治疗的费用。
只有普遍静脉血筛查能检测出所有BPb水平至少为0.48微摩尔/升（10微克/分升）的病例。普遍毛细血管血筛查能检测出93.2%至95.5%的病例，具体比例取决于BPb水平升高的患病率。针对性筛查是检测病例最不敏感的策略。静脉血检测能识别出77.3%至77.9%的病例，毛细血管血检测能检测出72.7%至72.8%的病例。在高患病率人群中，普遍静脉血筛查使每例病例的成本降至最低（490美元）。在低患病率和中等患病率人群中，使用静脉血检测的针对性筛查使每例病例的成本降至最低（分别为729美元和556美元）。在所有人群中，无论采用何种筛查策略，静脉血检测导致的每例病例成本均低于毛细血管血检测。对该模型中所有参数的敏感性分析表明这一结论是可靠的。
普遍筛查能检测出所有铅中毒病例，是高患病率人群中最具成本效益的策略。在患病率较低的人群中，使用针对性筛查检测出每例病例的成本低于普遍筛查。使用普遍筛查检测出更多病例的益处必须与筛查的额外成本相权衡。无论采用普遍筛查还是针对性筛查策略，使用静脉血检测的每例病例成本均低于毛细血管血检测。
