Cost-Accuracy Analysis of Chronic Obstructive Pulmonary Disease Screening in Low- and Middle-Income Countries.
Cost-Accuracy Analysis of Chronic Obstructive Pulmonary Disease Screening in Low- and Middle-Income Countries.
复制标题
低收入和中等收入国家慢性阻塞性肺疾病筛查的成本准确性分析。
DOI：
10.1164/rccm.202201-0071le
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发表时间：
2022
影响因子：
24.7
通讯作者：
GECoStudyInvestigators
中科院分区：
文献类型：
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作者：
Mohan,Sakshi;Cárdenas,MariaKathia;Ricciardi,Federico;Siddharthan,Trishul;Pollard,SuzanneL;Rykiel,NatalieA;Checkley,William;Hurst,JohnR;Soares,MartaO;GECoStudyInvestigators
以前曾报道过试验方法（4）。年龄> 40岁的个体从尼泊尔巴克塔普尔半城市、秘鲁利马城市和乌干达纳卡塞克农村的人群中随机选择。我们测试了初级保健中的COPD评估，以确定未诊断的呼吸系统疾病和加重风险（CAPTURE，包括呼气峰流量[PEF]），LMIC中的COPD评估-6（COLA-6，包括PEF）和肺功能问卷（LFQ，不包括PEF）。为了表征诊断途径，我们使用结构化决策树（图1）来考虑筛选访视达到个体的可能性、COPD患病率和筛选工具准确性。我们估计了工具的总体准确性，敏感性分析使用了特定于站点的准确性估计，调整了工具的阈值，以返回> 90%的敏感性。还考虑了个人访问医疗保健系统进行肺量测定确认诊断的可能性和肺量测定的可用性。从卫生系统的角度，使用CAPTURE、COLA-6和LFQ所需的时间以及外部来源的成本（包括肺量测定和对检测阳性者进行临床访视的成本）来计算每个步骤的成本。我们提出三个指标：1）每100个筛查个体的诊断检查成本; 2）每正确识别阴性或阳性病例的成本;以及3）每正确诊断阳性病例的成本。为了反映那些可以从治疗中受益的人，指标2和指标3只考虑了进入卫生系统的阳性病例。如母研究中所报告的，获得了研究报告，参与者提供了书面同意书（3，4）。该方法的详细说明可在https：//www.约克。AC. uk/media/che/documents/GECo1COST_Supplement. docx。
MethodsThe trial methodology has been previously reported (4). Individuals aged> 40 years were randomly selected from the population in semiurban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda. We tested COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE, which includes peak expiratory flow [PEF]), COPD in LMICs Assessment-6 (COLA-6, which includes PEF), and the Lung Function Questionnaire (LFQ, which does not include PEF). To characterize diagnostic pathways, we used a structured decision tree (Figure 1) to consider the likelihood of reaching individuals for the screening visit, prevalence of COPD, and screening tool accuracy. We estimated the overall accuracy of the tools, and a sensitivity analysis used site-specific accuracy estimates with thresholds for the tools adjusted to return a sensitivity⩾ 90%. The likelihood of individuals accessing the healthcare system for a spirometry-confirmed diagnosis and the availability of spirometry were also considered. Each step was costed from a health-system perspective using time taken to deliver CAPTURE, COLA-6, and LFQ, and externally sourced costs including the cost of spirometry and of a clinician visit for those testing positive. We present three metrics: 1) cost of diagnostic workup per 100 individuals screened; 2) cost per correctly identified negative or positive case; and 3) cost per correctly diagnosed positive case. To reflect those who could benefit from treatment, metrics 2 and 3 considered only positive cases who accessed the health system. Permissions were obtained and participants provided written consent as reported in the parent study (3, 4). A detailed description of the methodology is available at https://www. york. ac. uk/media/che/documents/GECo1COST_Supplement. docx.