Cost Analysis of Multiplex PCR Testing for Diagnosing Respiratory Virus Infections
Cost Analysis of Multiplex PCR Testing for Diagnosing Respiratory Virus Infections
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DOI：
10.1128/jcm.00556-09
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发表时间：
2009-09-01
影响因子：
9.4
通讯作者：
Goeree, Ron
中科院分区：
文献类型：
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作者：
Mahony, James B.;Blackhouse, Gord;Goeree, Ron
我们使用决策树模型进行了一项成本分析研究，以确定使用多重 PCR 检测呼吸道病毒（xTAG RVP 检测）是否比用于诊断儿科患者呼吸道病毒感染的现状检测方法成本更高或更低。决策树模型是通过使用四种呼吸道病毒检测策略构建的，即单独直接荧光抗体染色（DFA）、DFA加壳瓶培养（SVC）、单独xTAG RVP测试或DFA加xTAG RVP测试。通过对 661 名儿科患者的病历进行审查，确定住院时间、隔离天数、抗生素使用情况以及执行的所有其他医疗程序。按诊断状态划分的住院费用是根据每位患者的平均费用和决策树各组的患者人数确定的。 DFA 加 SVC 的每个案例成本最高，为 3,914 美元（以加元计），最低的是单独的 xTAG RVP 测试，为 3,623 美元，而单独 DFA 的成本（3,911 美元）和 DFA 加 RVP 的成本（3,849 美元）居中。当比较所有四种诊断策略时，成本最低的策略是当感染率等于或高于 11% 时单独进行 xTAG RVP 检测，而当感染率低于 11% 时则单独进行 DFA。这些数据表明，如果仅使用 xTAG RVP 检测策略来取代 DFA 加 SVC 的现状检测，则每个调查病例可节省 291 美元，根据对 1,820 名儿科住院患者样本的检测，加拿大安大略省汉密尔顿的四家医院每年可节省 529,620 美元的直接成本。我们得出的结论是，使用 xTAG RVP 测试是诊断儿童呼吸道病毒感染成本最低的策略，将为医院节省大量成本。
We performed a cost analysis study using decision tree modeling to determine whether the use of multiplex PCR testing for respiratory viruses (xTAG RVP test) is a more or less costly strategy than the status quo testing methods used for the diagnosis of respiratory virus infections in pediatric patients. The decision tree model was constructed by using four testing strategies for respiratory virus detection, viz., direct fluorescent-antibody staining (DFA) alone, DFA plus shell vial culture (SVC), the xTAG RVP test alone, or DFA plus the xTAG RVP test. A review of the charts of 661 pediatric patients was used to determine the length of hospital stay, the number of days in isolation, antibiotic usage, and all other medical procedures performed. The cost of hospitalization by diagnostic status was determined on the basis of the average cost per patient and the number of patients in each arm of the decision tree. The cost per case was the highest for DFA plus SVC at $3,914 ( in Canadian dollars), and the lowest was for the xTAG RVP test alone at $3,623, while the costs of DFA alone ($3,911) and DFA plus RVP ($3,849) were intermediate. When all four diagnostic strategies were compared, the least costly strategy was the xTAG RVP test alone when the prevalence of infection was 11% or higher and DFA alone when the prevalence was under 11%. These data indicate a savings of $291 per case investigated if the strategy of using the xTAG RVP test alone was used to replace the status quo test of DFA plus SVC, resulting in a savings of $529,620 per year in direct costs for the four Hamilton, Ontario, Canada, hospitals on the basis of the testing of specimens from 1,820 pediatric inpatients. We conclude that the use of the xTAG RVP test is the least costly strategy for the diagnosis of respiratory virus infections in children and would generate a significant savings for hospitals.