Quantifying the potential value of antigen-detection rapid diagnostic tests for COVID-19: a modelling analysis.
Quantifying the potential value of antigen-detection rapid diagnostic tests for COVID-19: a modelling analysis.
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DOI：
10.1186/s12916-021-01948-z
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发表时间：
2021-03-09
期刊：
影响因子：
9.3
通讯作者：
Arinaminpathy N
中科院分区：
文献类型：
--
作者：
Ricks S;Kendall EA;Dowdy DW;Sacks JA;Schumacher SG;Arinaminpathy N
检测在应对COVID-19大流行的治疗和预防中发挥着关键作用。与核酸检测（NAT）相比，抗原检测快速诊断检测（Ag-RDTs）更容易获得，但通常具有较低的灵敏度和特异性。通过量化这些权衡，我们旨在为Ag-RDT何时能提供比依赖NAT更大的公共卫生价值的决策提供信息。在专家咨询后，我们选择了两个用例进行分析：在“医院”环境中迅速识别因呼吸道症状入院的患者中的COVID-19感染者，并及早识别和隔离症状轻微的COVID-19感染者-19在“社区”里使用决策分析，我们评估了卫生系统的成本和健康的影响（避免死亡和隔离感染天）的Ag-RDT主导的战略，相比NAT和临床判断的基础上的战略。我们采用了广泛的价值观的“上下文”参数相关的一系列设置，包括NAT的可用性和临床判断的性能。我们对所有这些参数进行了多变量敏感性分析。在医院环境中，当临床判断的灵敏度低于90%时，Ag-RDT主导的策略将避免比基于NAT的策略更多的死亡，并且避免的每例死亡的成本更低，并且当NAT结果及时提供给少于85%的患者的临床决策时。Ag-RDT的使用在社区环境中得到了强有力的支持，在广泛的假设下，它将以比单独依赖NAT更低的成本避免更多的传输。尽管其灵敏度和特异性不完美，但Ag-RDT有可能同时更具影响力，并且比目前的COVID-19诊断检测方法具有更低的每例死亡和避免感染人日成本。在线版本包含补充材料，可通过10.1186/s12916-021-01948-z获得。
Testing plays a critical role in treatment and prevention responses to the COVID-19 pandemic. Compared to nucleic acid tests (NATs), antigen-detection rapid diagnostic tests (Ag-RDTs) can be more accessible, but typically have lower sensitivity and specificity. By quantifying these trade-offs, we aimed to inform decisions about when an Ag-RDT would offer greater public health value than reliance on NAT. Following an expert consultation, we selected two use cases for analysis: rapid identification of people with COVID-19 amongst patients admitted with respiratory symptoms in a ‘hospital’ setting and early identification and isolation of people with mildly symptomatic COVID-19 in a ‘community’ setting. Using decision analysis, we evaluated the health system cost and health impact (deaths averted and infectious days isolated) of an Ag-RDT-led strategy, compared to a strategy based on NAT and clinical judgement. We adopted a broad range of values for ‘contextual’ parameters relevant to a range of settings, including the availability of NAT and the performance of clinical judgement. We performed a multivariate sensitivity analysis to all of these parameters. In a hospital setting, an Ag-RDT-led strategy would avert more deaths than a NAT-based strategy, and at lower cost per death averted, when the sensitivity of clinical judgement is less than 90%, and when NAT results are available in time to inform clinical decision-making for less than 85% of patients. The use of an Ag-RDT is robustly supported in community settings, where it would avert more transmission at lower cost than relying on NAT alone, under a wide range of assumptions. Despite their imperfect sensitivity and specificity, Ag-RDTs have the potential to be simultaneously more impactful, and have a lower cost per death and infectious person-days averted, than current approaches to COVID-19 diagnostic testing. The online version contains supplementary material available at 10.1186/s12916-021-01948-z.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
在感染期间，什么时候可以检测到SARS-COV-2，并且不再使用基于RT-PCR的测试检测到？对个别参与者数据的系统审查。
影响因子：
9.3
作者：
Mallett S;Allen AJ;Graziadio S;Taylor SA;Sakai NS;Green K;Suklan J;Hyde C;Shinkins B;Zhelev Z;Peters J;Turner PJ;Roberts NW;di Ruffano LF;Wolff R;Whiting P;Winter A;Bhatnagar G;Nicholson BD;Halligan S
通讯作者：
Halligan S
影响因子：
11.1
作者：
Lechien, Jerome R.;Chiesa-Estomba, Carlos M.;Saussez, Sven
通讯作者：
Saussez, Sven
影响因子：
82.9
作者：
He, Xi;Lau, Eric H. Y.;Leung, Gabriel M.
通讯作者：
Leung, Gabriel M.
影响因子：
3.7
作者：
Arevalo-Rodriguez I;Buitrago-Garcia D;Simancas-Racines D;Zambrano-Achig P;Del Campo R;Ciapponi A;Sued O;Martinez-García L;Rutjes AW;Low N;Bossuyt PM;Perez-Molina JA;Zamora J
通讯作者：
Zamora J