Risk-stratification in febrile infants 29 to 60 days old: a cost-effectiveness analysis.
Risk-stratification in febrile infants 29 to 60 days old: a cost-effectiveness analysis.
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DOI：
10.1186/s12887-021-03057-5
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发表时间：
2022-02-03
期刊：
影响因子：
2.4
通讯作者：
Smith KJ
中科院分区：
文献类型：
--
作者：
Noorbakhsh KA;Ramgopal S;Rixe NS;Dunnick J;Smith KJ
多项临床预测规则已被公布用于对发烧婴儿≤60 日龄的严重细菌感染(SBI)进行风险分层，这种情况出现在8-13%的婴儿中。我们评估了在急诊科识别婴儿SBI的策略的成本-效果。我们开发了一个马尔可夫决策模型来评估外表良好、发烧的足月儿的结局，使用了以下策略：波士顿、罗切斯特、费城、修改后的费城、儿科急救应用研究网络(PECARN)、逐步、亚伦森和临床怀疑。使用每种策略将婴儿归类为低风险或非低风险。从医疗保健的角度对模拟队列进行了为期1年的跟踪调查。我们的主要模型侧重于菌血症，次要模型为尿路感染和细菌性脑膜炎。进行了单向、结构和概率敏感性分析。主要结果是正确诊断了SBI，获得了每质量调整生命年的增量成本(QALY)。在菌血症模型中，PECARN策略是最便宜的策略($3671，0.779 QALY)。波士顿战略是最具成本效益的战略，每QALY成本为9799美元。所有其他战略都不那么有效，成本也更高。尽管初始成本很低，但临床怀疑是最昂贵和最无效的策略之一。结果对所选策略的特异性很敏感。在概率敏感性分析中，波士顿策略最有可能在10万美元/QALY的支付意愿门槛下受到青睐。在尿路感染模型中，PECARN比其他策略更受欢迎，而在细菌性脑膜炎模型中，Boston策略更受欢迎。波士顿临床预测规则提供了一种经济上合理的策略，与其他方法相比，用于识别SBI。
Multiple clinical prediction rules have been published to risk-stratify febrile infants ≤60 days of age for serious bacterial infections (SBI), which is present in 8-13% of infants. We evaluate the cost-effectiveness of strategies to identify infants with SBI in the emergency department. We developed a Markov decision model to estimate outcomes in well-appearing, febrile term infants, using the following strategies: Boston, Rochester, Philadelphia, Modified Philadelphia, Pediatric Emergency Care Applied Research Network (PECARN), Step-by-Step, Aronson, and clinical suspicion. Infants were categorized as low risk or not low risk using each strategy. Simulated cohorts were followed for 1 year from a healthcare perspective. Our primary model focused on bacteremia, with secondary models for urinary tract infection and bacterial meningitis. One-way, structural, and probabilistic sensitivity analyses were performed. The main outcomes were SBI correctly diagnosed and incremental cost per quality-adjusted life-year (QALY) gained. In the bacteremia model, the PECARN strategy was the least expensive strategy ($3671, 0.779 QALYs). The Boston strategy was the most cost-effective strategy and cost $9799/QALY gained. All other strategies were less effective and more costly. Despite low initial costs, clinical suspicion was among the most expensive and least effective strategies. Results were sensitive to the specificity of selected strategies. In probabilistic sensitivity analyses, the Boston strategy was most likely to be favored at a willingness-to-pay threshold of $100,000/QALY. In the urinary tract infection model, PECARN was preferred compared to other strategies and the Boston strategy was preferred in the bacterial meningitis model. The Boston clinical prediction rule offers an economically reasonable strategy compared to alternatives for identification of SBI.
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影响因子：
3.7
作者：
Hoshi SL;Kondo M;Okubo I
通讯作者：
Okubo I
影响因子：
5.1
作者：
DAGAN, R;POWELL, KR;MENEGUS, MA
通讯作者：
MENEGUS, MA
影响因子：
4.4
作者：
Garra, G;Cunningham, SJ;Crain, EF
通讯作者：
Crain, EF
DOI：
10.1001/archpedi.1983.02140380006003
发表时间：
1983-01-01
影响因子：
--
作者：
DEANGELIS, C;JOFFE, A;WILLIS, E
通讯作者：
WILLIS, E
影响因子：
8
作者：
Kaplan, RL;Harper, MB;Mandl, KD
通讯作者：
Mandl, KD