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首页> 外文期刊>Journal of Clinical Microbiology >Cost-Effectiveness Analysis of Multiplex PCR with Magnetic Resonance Detection versus Empiric or Blood Culture-Directed Therapy for Management of Suspected Candidemia
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Cost-Effectiveness Analysis of Multiplex PCR with Magnetic Resonance Detection versus Empiric or Blood Culture-Directed Therapy for Management of Suspected Candidemia

机译：磁共振检测与经验性或血液培养定向疗法治疗疑似念珠菌血症的多重PCR的成本-效果分析

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Candida bloodstream infections (BSI) are associated with significant morbidity, mortality, and increased health care costs. Early treatment is essential, because delayed therapy detrimentally impacts clinical outcomes. The FDA recently approved the first culture-independent direct molecular detection method for Candida BSIs (T2Candida). The speed and sensitivity of this assay give it the potential to improve patient care, but the reagents and instrumentation are expensive. We used an analytic decision tree model to compare the cost-effectiveness of T2Candida-directed antifungal therapy (T2DT) to that of either empirical therapy (ET) or blood culture-directed therapy (BCDT). The costs included those of T2Candida testing, antifungal treatment, and hospital length of stay. The effectiveness measure was survival status at hospital discharge. T2DT was less costly and more effective than BCDT but was less costly and less effective than ET with an echinocandin (incremental cost-effectiveness ratio, $111,084 per additional survivor). One-way sensitivity analyses demonstrated that the cost-effectiveness of T2DT was highly dependent on Candida BSI prevalence and the cost of antifungal therapy and T2Candida test reagents. The use of T2DT reduced the number of unnecessarily treated patients by 98% relative to that with ET. Reduced drug exposure might lessen the possibility of drug-related adverse events and may also prevent the development of antifungal resistance or emergence of drug-resistant Candida species. The greatest benefit of T2Candida appears to be the ability to confidently withhold or stop empirical antifungal therapy in low-to-moderate-risk patients who are unlikely to benefit from treatment.
机译：念珠菌血流感染（BSI）与明显的发病率，死亡率和增加的医疗保健费用有关。早期治疗至关重要，因为延迟治疗会对临床结果产生不利影响。 FDA最近批准了第一个针对假丝酵母BSI（T2Candida）的不依赖培养物的直接分子检测方法。该测定法的速度和灵敏度使其有可能改善患者护理，但试剂和仪器价格昂贵。我们使用分析决策树模型比较了T2Candida定向抗真菌治疗（T2DT）与经验治疗（ET）或血液培养定向治疗（BCDT）的成本效益。费用包括T2Candida测试，抗真菌治疗和住院时间的费用。有效性指标为出院时的生存状况。 T2DT与BCDT相比，成本更低，更有效，但与棘皮菌素相比，ET2的成本更低，效果也更低（增量成本效益比，每增加一个幸存者$ 111,084）。单向敏感性分析表明，T2DT的成本效益高度依赖于念珠菌BSI的患病率以及抗真菌治疗和T2Candida测试试剂的成本。与ET相比，T2DT的使用使不必要治疗的患者数量减少了98％。减少药物接触可能会减少与药物相关的不良事件的可能性，也可能会阻止抗真菌药耐药性的产生或耐药念珠菌的出现。 T2Candida的最大好处似乎是能够在不太可能受益于治疗的中低风险患者中自信地停止或停止经验性抗真菌治疗。

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