Costs and consequences of universal sibling screening for vesicoureteral reflux: decision analysis.
Costs and consequences of universal sibling screening for vesicoureteral reflux: decision analysis.
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DOI：
10.1542/peds.2010-0744
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发表时间：
2010-11
期刊：
影响因子：
8
通讯作者：
Nelson CP
中科院分区：
文献类型：
--
作者：
Routh JC;Grant FD;Kokorowski P;Lee RS;Fahey FH;Treves ST;Nelson CP
我们的目的是评估膀胱输尿管反流（VUR）筛查在VUR患者兄弟姐妹中的成本、辐射暴露和避免发热性尿路感染（fUTIs）的数量。我们构建了一个马尔可夫模型来评估两种相互竞争的治疗方案，即普遍筛查（对所有无症状的兄弟姐妹进行膀胱造影评估）和常规护理（仅对fUTIs后的兄弟姐妹进行膀胱造影评估）。所有模型输入均使用已发表的数据。成本是用社会观点来估计的。普遍筛查产生2980个fUTIs，而常规护理产生6330个。因此，在10万名1岁无症状的兄弟姐妹中进行VUR的普遍筛查，每3360名兄弟姐妹中预防了1例首次fUTI，与常规护理相比，每个避免fUTI的额外费用为55600美元。这些估计严重依赖于筛查年龄和抗生素预防的有效性；预防单一fUTI需要对166名5岁的兄弟姐妹和694名10岁的兄弟姐妹进行筛查。同样，如果预防在预防fUTI方面无效，那么将需要对多达1万名兄弟姐妹进行筛查，以预防单一fUTI。预防单一fUTI需要对30至430名1岁无症状的兄弟姐妹进行筛查，每例fUTI的估计额外费用为5.6万至82万美元。这些估计在很大程度上取决于筛查年龄和抗生素预防的有效性。
Our objective was to evaluate screening for vesicoureteral reflux (VUR) among siblings of patients with VUR, in terms of cost, radiation exposure, and number of febrile urinary tract infections (fUTIs) averted. We constructed a Markov model to evaluate 2 competing management options, that is, universal screening (cystographic evaluation of all siblings without symptoms) and usual care (cystographic evaluation of siblings only after fUTIs). Published data were used to inform all model inputs. Costs were estimated by using a societal perspective. Universal screening yielded 2980 fUTIs, whereas usual care yielded 6330. Therefore, universal screening for VUR in a cohort of 100 000 siblings 1 year of age without symptoms resulted in the prevention of 1 initial fUTI per 3360 siblings, at an excess cost of $55 600 per averted fUTI, in comparison with usual care. These estimates were heavily dependent on screening age and the effectiveness of antibiotic prophylaxis; prevention of a single fUTI would require screening of 166 siblings 5 years of age and 694 siblings 10 years of age. Similarly, if prophylaxis was ineffective in preventing fUTIs, then up to 10 000 siblings would need to be screened for prevention of a single fUTI. Prevention of a single fUTI would require screening of 30 to 430 siblings 1 year of age without symptoms, at an estimated excess cost of $56000 to $820000 peraverted fUTI. These estimates are heavily dependent on screening age and the effectiveness of antibiotic prophylaxis.
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DOI：
10.1056/nejmoa0901249
发表时间：
2009-08-27
期刊：
The New England journal of medicine
影响因子：
--
作者：
Fazel R;Krumholz HM;Wang Y;Ross JS;Chen J;Ting HH;Shah ND;Nasir K;Einstein AJ;Nallamothu BK
通讯作者：
Nallamothu BK
影响因子：
6.6
作者：
Ellison, Jonathan S.;Maxfield, Charles M.;Wiener, John S.
通讯作者：
Wiener, John S.
影响因子：
6.6
作者：
Parekh, DJ;Pope, JC;Brock, JW
通讯作者：
Brock, JW
影响因子：
1.7
作者：
Sureshkumar, Premala;Jones, Mike;Craig, Jonathan C.
通讯作者：
Craig, Jonathan C.
影响因子：
1.4
作者：
Unver, Tamer;Alpay, Harika;Ones, Tunc
通讯作者：
Ones, Tunc