The rapid test paradox:: When fewer cases defected lead to more cases treated -: A decision analysis of tests for Chlamydia trachomatis

被引:116
作者
Gift, TL
Pate, MS
Hook, EW
Kassler, WJ
机构
[1] Ctr Dis Control & Prevent, Atlanta, GA 30333 USA
[2] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA
[3] Jefferson Cty Dept Hlth, Birmingham, AL USA
关键词
D O I
10.1097/00007435-199904000-00010
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background and Objectives: Screening tests for detection of Chlamydia trachomatis include those processed in laboratories and those designed to be processed at the point of care. The latter tests can yield results at the time of the initial patient visit, but most available lab-processed tests have greater sensitivity, In settings where a proportion of patients do not return for treatment after positive test results, the less sensitive rapid tests could lead to the treatment of more patients and be more cost-effective. Goal of this Study: To determine the situations, if any, in which a rapid test might be more cost-effective and treat more infections than lab-based tests. Study Design: A decision analysis framework was used to compare one point-of-care test (the BioStar Chlamydia OIA) with two lab-based tests (cell culture and the polymerase chain reaction [PCR] assay). It was assumed that all women in the model would be screened. Variables included in the analysis were the prevalence, test sensitivity and specificity, the probability of developing pelvic inflammatory disease after treated and untreated chlamydial infections, and the likelihood that patients would wait for rapid test results or return to the facility for treatment. Results: The rapid test treated more cases of infection than the PCR alone if the return rate was less than 65%. A two-test algorithm of the rapid test followed by a PCR test on those initially testing negative identified and treated the greatest number of chlamydial infections and was the most cost-effective at all prevalences above 9%, but this finding was sensitive to the cost estimate for pelvic inflammatory disease. Conclusion: In settings where patient return for treatment is a problem, point-of-care tests contribute significantly to the detection and treatment of chlamydial infections among women.
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页码:232 / 240
页数:9
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共 43 条
[1]   DECREASED PREVALENCE OF CHLAMYDIA-TRACHOMATIS INFECTION ASSOCIATED WITH A SELECTIVE SCREENING-PROGRAM IN FAMILY-PLANNING CLINICS IN WISCONSIN [J].
ADDISS, DG ;
VAUGHN, ML ;
LUDKA, D ;
PFISTER, J ;
DAVIS, JF .
SEXUALLY TRANSMITTED DISEASES, 1993, 20 (01) :28-35
[2]  
[Anonymous], HIDDEN EPIDEMIC CONF
[3]   Individual and population approaches to the epidemiology and prevention of sexually transmitted diseases and human immunodeficiency virus infection - Overview [J].
Aral, SO ;
Holmes, KK ;
Padian, NS ;
Cates, W .
JOURNAL OF INFECTIOUS DISEASES, 1996, 174 :S127-S133
[4]  
BACHMANN LH, 1997, INT C SEX TRANSM DIS, pP793
[6]  
*BUR LAB STAT, 1998, AV HOURL WEEKL EARN
[7]   ATYPICAL PELVIC INFLAMMATORY DISEASE - CAN WE IDENTIFY CLINICAL PREDICTORS [J].
CATES, W ;
JOESOEF, MR ;
GOLDMAN, MB .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1993, 169 (02) :341-346
[8]  
*CDCP, 1998, SEX TRANSM DIS SUR S
[9]  
Childs James E., 1993, Morbidity and Mortality Weekly Report, V42, P1
[10]   Comparison of performance and cost-effectiveness of direct fluorescent-antibody, ligase chain reaction, and PCR assays for verification of chlamydial enzyme immunoassay results for populations with a low to moderate prevalence of Chlamydia trachomatis infection [J].
Dean, D ;
Ferrero, D ;
McCarthy, M .
JOURNAL OF CLINICAL MICROBIOLOGY, 1998, 36 (01) :94-99