Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates
Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates
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DOI：
10.1001/archpedi.162.7.665
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发表时间：
2008-07-01
影响因子：
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通讯作者：
Cantor, Scott B.
中科院分区：
文献类型：
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作者：
Caviness, A. Chantal;Demmler, Gail J.;Cantor, Scott B.
目的：确定对出生至 28 天发热新生儿单纯疱疹病毒（HSV）感染进行检测和经验性治疗的临床效果和成本效益。设计：成本效益分析。设置：决策模型。患者：发热无其他症状的新生儿和发热伴脑脊液（CSF）细胞增多的新生儿。干预措施：四种临床策略：（1）HSV 检测和等待检测时的经验性治疗结果； （2）HSV检测，如果检测结果呈HSV阳性或患者出现HSV症状，则进行治疗； (3)单独治疗而不进行检测； (4) 除非患者出现症状，否则不进行 HSV 检测或治疗。使用的 2 种 HSV 检测方法是 CSF HSV 聚合酶链反应 (PCR) 以及血液 HSV PCR、CSF HSV PCR 和多种病毒培养物的综合评估。主要结果指标：12 个月生存率和质量调整预期寿命，每个质量调整生命年 (QALY) 的成本效益阈值为 100 000 美元。结果：临床策略 1，应用于患有 CSF 的发热新生儿时细胞增多症，每 10 000 名新生儿挽救了 17 条生命，并且使用 CSF HSV PCR 检测具有成本效益（/QALY 获得 55 652 美元）。在所有发热新生儿中应用临床策略 1 的成本效益取决于 CSF HSV PCR 的成本、疾病的患病率以及父母对神经发育结果的偏好。使用全面 HSV 检测的临床策略对于发热新生儿（获得 368 411 美元/QALY）或伴有脑脊液细胞增多症的发热新生儿（获得 110 190 美元/QALY）并不具有成本效益。结论：使用脑脊液 HSV PCR 检测和阿昔洛韦钠经验性治疗可挽救生命，并且对于伴有脑脊液细胞增多症的发热新生儿具有成本效益。对于所有发热新生儿来说，这并不是一种具有成本效益的医疗保健资源使用方式。
Objective: To determine the clinical effectiveness and cost-effectiveness of testing for and empirically treating herpes simplex virus (HSV) infection in neonates with fever aged from birth to 28 days.Design: Cost-effectiveness analysis.Setting: Decision model.Patients: Neonates with fever with no other symptoms and neonates with fever with cerebrospinal fluid (CSF) pleocytosis.Interventions: Four clinical strategies: (1) HSV testing and empirical treatment while awaiting test results; (2) HSV testing and treatment if test results were positive for HSV or the patient had symptoms of HSV; (3) treatment alone without testing; or (4) no HSV testing or treatment unless the patient exhibited symptoms. The 2 HSV testing methods used were CSF HSV polymerase chain reaction (PCR) and comprehensive evaluation with blood HSV PCR, CSF HSV PCR, and multiple viral cultures.Main Outcome Measures: Twelve-month survival and quality-adjusted life expectancy with a cost-effectiveness threshold of $100 000 per quality-adjusted life year (QALY) gained.Results: Clinical strategy 1, when applied in febrile neonates with CSF pleocytosis, saved 17 lives per 10 000 neonates and was cost-effective using CSF HSV PCR testing ($55 652/QALY gained). The cost-effectiveness of applying clinical strategy 1 in all febrile neonates depended on the cost of the CSF HSV PCR, prevalence of disease, and parental preferences for neurodevelopmental outcomes. Clinical strategies using comprehensive HSV testing were not cost-effective in febrile neonates ($368 411/QALY gained) or febrile neonates with CSF pleocytosis ($ 110 190/QALY gained).Conclusions: Testing with CSF HSV PCR and empirically treating with acyclovir sodium saves lives and is cost-effective in febrile neonates with CSF pleocytosis. It is not a cost-effective use of health care resources in all febrile neonates.