An early evaluation of clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoea in genitourinary medicine clinics in England.
An early evaluation of clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoea in genitourinary medicine clinics in England.
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DOI：
10.1136/sextrans-2013-051147
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发表时间：
2014-03
影响因子：
3.6
通讯作者：
Adams EJ
中科院分区：
文献类型：
--
作者：
Turner KM;Round J;Horner P;Macleod J;Goldenberg S;Deol A;Adams EJ
与标准场外实验室检测相比，评估在泌尿生殖医学 (GUM) 诊所中纳入衣原体和淋病护理点 (POC) 核酸扩增检测 (NAAT) 的临床路径的成本和效益。我们模拟了英格兰 120 万 GUM 诊所的就诊者。我们开发了 Microsoft Excel 中的模拟，以将衣原体和淋病的现有标准管理途径与 POC NAAT 进行比较。我们进行了情景分析来评估模型结果的稳健性。主要结果是增量成本效益比。次要结果包括不适当治疗、并发症和避免的传播的数量。使用 POC NAAT 点的基线成本为 1.039 亿英镑，而标准护理的基线成本为 1.156 亿英镑。 POC NAAT 还与 46 个质量调整生命年的小幅增加相关，使新测试更有效、更便宜。使用 POC NAAT 可以避免超过 95 000 次不适当的治疗。患者在检测当天接受诊断和治疗，这还可以每年预防 189 例盆腔炎病例和 17 561 例进一步传播。用 POC 检测取代衣原体和淋病的标准实验室检测可以节省成本，并且患者将受益于更准确的诊断和更少不必要的治疗。目前，过度治疗约占已报告的衣原体和淋病治疗的十分之一，POC NAAT 将有效消除推定治疗的需要。
To estimate the costs and benefits of clinical pathways incorporating a point of care (POC) nucleic acid amplification test (NAAT) for chlamydia and gonorrhoea in genitourinary medicine (GUM) clinics compared with standard off-site laboratory testing. We simulated 1.2 million GUM clinic attendees in England. A simulation in Microsoft Excel was developed to compare existing standard pathways of management for chlamydia and gonorrhoea with a POC NAAT. We conducted scenario analyses to evaluate the robustness of the model findings. The primary outcome was the incremental cost-effectiveness ratio. Secondary outcomes included the number of inappropriate treatments, complications and transmissions averted. The baseline cost of using the point of POC NAAT was £103.9 million compared with £115.6 million for standard care. The POC NAAT was also associated with a small increase of 46 quality adjusted life years, making the new test both more effective and cheaper. Over 95 000 inappropriate treatments might be avoided by using a POC NAAT. Patients receive diagnosis and treatment on the same day as testing, which may also prevent 189 cases of pelvic inflammatory disease and 17 561 onward transmissions annually. Replacing standard laboratory tests for chlamydia and gonorrhoea with a POC test could be cost saving and patients would benefit from more accurate diagnosis and less unnecessary treatment. Overtreatment currently accounts for about a tenth of the reported treatments for chlamydia and gonorrhoea and POC NAATs would effectively eliminate the need for presumptive treatment.
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影响因子：
3.1
作者：
Gift, TL;Pate, MS;Kassler, WJ
通讯作者：
Kassler, WJ
影响因子：
1.4
作者：
Bignell, C.;FitzGerald, M.
通讯作者：
FitzGerald, M.
影响因子：
9.4
作者：
Goldenberg, S. D.;Finn, J.;Tong, C. Y. W.
通讯作者：
Tong, C. Y. W.
影响因子：
3.7
作者：
Hsieh YH;Gaydos CA;Hogan MT;Uy OM;Jackman J;Jett-Goheen M;Albertie A;Dangerfield DT 2nd;Neustadt CR;Wiener ZS;Rompalo AM
通讯作者：
Rompalo AM
影响因子：
3.6
作者：
Adams, Elisabeth J.;Turner, Katherine M. E.;Edmunds, W. John
通讯作者：
Edmunds, W. John