Treat or test first? Decision analysis of empirical antiviral treatment of influenza virus infection versus treatment based on rapid test results

被引:41
作者
Sintchenko, V [1 ]
Gilbert, GL
Coiera, E
Dwyer, D
机构
[1] Univ New S Wales, Ctr Hlth Informat, Sydney, NSW 2052, Australia
[2] Westmead Hosp, Inst Clin Pathol & Med Res, Ctr Infect Dis, Westmead, NSW 2145, Australia
[3] Westmead Hosp, Inst Clin Pathol & Med Res, Microbiol Lab Serv, Westmead, NSW 2145, Australia
关键词
decision analysis; influenza; laboratory diagnosis; treatment;
D O I
10.1016/S1386-6532(00)00182-7
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
Background: neuraminidase (NA) inhibitors have recently become available for treatment of influenza. Rapid antigen detection assays at 'point-of-care' may improve the accuracy of clinical diagnosis, but the value of these techniques in assisting with the appropriate use of antivirals remains controversial. Objective: to compare the diagnostic utilities of two management strategies for influenza, empirical antiviral therapy versus therapy based on a positive rapid test result in pre-epidemic and epidemic periods. Study design: a threshold decision analytic model was designed to compare these competing strategies and sensitivity analysis performed to examine the impact of diagnostic variables on the expected utility of the decision with a range of prior probabilities of infection between 1 and 50%. Results: on the basis of the calculated sensitivity (77%) and specificity (95%) of a point-of-care test for influenza, pre-treatment testing was preferred and cost-effective in non-epidemic stage of the influenza cycle. The alternative strategy of empirical treatment produces a higher utility value during epidemics, but may result in overuse of antivirals for low-risk populations. The two strategies had equivalent efficacy when the probability of influenza was 42%. Conclusions: Patients with flu-like illness, who present outside the influenza outbreak and are considered to be at low risk for influenza-related complications, should be tested to confirm the diagnosis before starting antiviral treatment with a NA inhibitor. The most important variables in the model were the accuracy of the clinical diagnosis and the pre-test probability of influenza. A threshold probability of influenza of 42% would dictate changing from the rapid testing strategy to a 'treat regardless' strategy. (C) 2002 Elsevier Science B.V. All rights reserved.
引用
收藏
页码:15 / 21
页数:7
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