The rapid test paradox:: When fewer cases defected lead to more cases treated -: A decision analysis of tests for Chlamydia trachomatis
The rapid test paradox:: When fewer cases defected lead to more cases treated -: A decision analysis of tests for Chlamydia trachomatis
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DOI：
10.1097/00007435-199904000-00010
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发表时间：
1999-04-01
影响因子：
3.1
通讯作者：
Kassler, WJ
中科院分区：
文献类型：
--
作者：
Gift, TL;Pate, MS;Kassler, WJ
背景和目的：检测沙眼衣原体的筛查试验包括实验室处理的沙眼衣原体筛查试验和设计在护理地点处理的沙眼衣原体筛查试验。后一种测试可以在患者初次就诊时得出结果，但大多数可用的实验室处理的测试具有更高的敏感性，在一定比例的患者在测试结果呈阳性后不再返回治疗的情况下，灵敏度较低的快速测试可能会导致更多患者的治疗，并且更具成本效益。本研究的目标：确定情况，如果有的话，其中，快速检测可能比基于实验室的检测更具成本效益，并且可以治疗更多的感染。研究设计：使用决策分析框架来比较一种护理点检测(BioStar Clamydia OIA)和两种基于实验室的检测(细胞培养和聚合酶链式反应(PCR)检测)。人们假设模特中的所有女性都会接受筛查。分析中包含的变量包括患病率、检测敏感性和特异性、治疗和未治疗的衣原体感染后发生盆腔炎的可能性，以及患者等待快速检测结果或返回机构进行治疗的可能性。结果：当返回率低于65%时，快速检测治疗的感染病例比单独使用聚合酶链式反应治疗的病例多。先进行快速检测，然后再对最初检测为阴性的患者进行聚合酶链式反应检测的两种检测算法识别和治疗的衣原体感染数量最多，并且在9%以上的所有流行率下是最具成本效益的，但这一发现对盆腔炎的成本估计很敏感。结论：在患者返回治疗是一个问题的环境中，护理点检测对发现和治疗女性衣原体感染具有重要意义。
Background and Objectives: Screening tests for detection of Chlamydia trachomatis include those processed in laboratories and those designed to be processed at the point of care. The latter tests can yield results at the time of the initial patient visit, but most available lab-processed tests have greater sensitivity, In settings where a proportion of patients do not return for treatment after positive test results, the less sensitive rapid tests could lead to the treatment of more patients and be more cost-effective.Goal of this Study: To determine the situations, if any, in which a rapid test might be more cost-effective and treat more infections than lab-based tests.Study Design: A decision analysis framework was used to compare one point-of-care test (the BioStar Chlamydia OIA) with two lab-based tests (cell culture and the polymerase chain reaction [PCR] assay). It was assumed that all women in the model would be screened. Variables included in the analysis were the prevalence, test sensitivity and specificity, the probability of developing pelvic inflammatory disease after treated and untreated chlamydial infections, and the likelihood that patients would wait for rapid test results or return to the facility for treatment.Results: The rapid test treated more cases of infection than the PCR alone if the return rate was less than 65%. A two-test algorithm of the rapid test followed by a PCR test on those initially testing negative identified and treated the greatest number of chlamydial infections and was the most cost-effective at all prevalences above 9%, but this finding was sensitive to the cost estimate for pelvic inflammatory disease.Conclusion: In settings where patient return for treatment is a problem, point-of-care tests contribute significantly to the detection and treatment of chlamydial infections among women.