五种方法检测产碳青霉烯酶肠杆菌科细菌的卫生经济学评价

目的分析PCR(A方法)、Carba NP试验(B方法)、紫外分光光度法(C方法)、改良碳青霉烯灭活法(mCIM,D方法)和环介导等温扩增(LAMP,E方法)5种检测产碳青霉烯酶肠杆菌科细菌(CPE)方法的成本和检验性能。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data和CBM数据库,搜集具有相同或相似设计、相同目的和独立结果的关于CPE检测的文献,检索时限均为2009年5月~2019年5月。对各方法的成本和检验性能数据进行提取,将效用中的"灵敏性、特异性、简便性、快速性"等4个医学检验专业性指标量化为具体数值,利用药物经济学分析方法中的成本-效果分析(cost-effective analysis,CEA)、成本-效用分析(cost-utility analysis,CUA)和多属性效用理论(multi-attribute utility theory,MAUT)对5种检测CPE的方法进行卫生经济学评价。结果 A、B、C、D、E方法的成本分别为210.00元、22.00元、10.50元、6.00元和60.00元,A、B、C、D、E方法的CEA的C/E分别为210.00、22.96、10.66、6.14和60.00。A、B、C、D、E方法的CUA的C/U分别为302.16、32.13、19.30、11.13和80.00。A、B、C、D、E方法的MAUT值分别为42.56、5.00、2.54、1.63和12.56。结论从CEA、CUA及MAUT的角度看,改良碳青霉烯灭活法的经济学价值最好,一般情况下可作为常规检测CPE方法;但其操作时间长,在临床严重感染需要快速检测时可采用环介导等温扩增法,更兼具经济性和快速性。

Health economics assessment of five methods for detection of carbapenemase-producing Enterobacteriaceae

Objectives To analyze the cost and performance of five methods for detection of carbapenemase-producing Enterobacteriaceae(CPE),including PCR(method A),Carba NP test(method B),ultraviolet spectrophotometry(method C),modified carbapenem inactivation method(mCIM,method D),and loop-mediated isothermal amplification(LAMP,method E).Methods PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data and CBM databases were searched online regarding literature on detection of CPE with identical or similar designs,identical objectives,and independent results.The search was limited between May 2009 and May 2019.Data on the cost and detection performance of all five methods were extracted,and the four special indexes for laboratory tests,namely sensitivity,specificity,simplicity,and rapidity in the utility were quantified as specific values;subsequently,the costeffective analysis(CEA),cost-utility analysis(CUA),and multi-attribute utility theory(MAUT)in the detection economic analysis were used to conduct health economics evaluation of five detection methods for CPE.Results The cost of methods A,B,C,D and E were 210.00 yuan,22.00 yuan,10.50 yuan,6.00 yuan,and 60.00 yuan,respectively.The C/E of CEA for the above five methods were 210.00,22.96,10.66,6.14,and 60.00,respectively.The C/U of CUA for the above five methods were 302.16,32.13,19.30,11.13,and 80.00,respectively.The MAUT value of the above five methods were 42.56,5.00,2.54,1.63,and 12.56,respectively.Conclusions In terms of CEA,CUA,and MAUT,method D was the highest in economic value,which usually can be used as a routine method for detecting CPE,while it requires a long procedure time;thus,method E can be used for rapid detection in occurrence of clinical severe infection,which is superior in both costeffectiveness and rapidity.