摘要
本研究的目的是分析人类免疫缺陷病毒(HIV)感染患者卡氏肺孢子虫肺炎(PCP)四种诊断策略的成本-效果比。210例疑似PCP的hiv感染患者行诱导痰(IS),阴性者行支气管肺泡灌洗(BAL);其中85例患者能够在诱导痰和BAL前进行运动试验(ET)。分析了以下策略:BAL策略(当怀疑PCP时进行BAL);IS策略(诱导痰,阴性者灌洗);运动试验(ET)策略,(ET后若结果不正常则行BAL);ES(运动痰)策略(即仅在ET异常和IS阴性后进行BAL)。每项战略的成本都是通过只考虑直接成本来计算的;还评价了两项既定战略将成为费用相等的条件。该人群PCP患病率为31%; IS had 100% specificity and 71% sensitivity, whilst ET had 100% sensitivity and 77% specificity. The costs of BAL, IS, ET and ES strategies were 210,000, 191,940, 140,700 and 112,700 FF, respectively. The ES strategy is, thus, most suitable for our unit. The most economic strategy depends not only on the cost and characteristics of the procedures, but also on the prevalence of PCP in the test population. In conclusion, we developed a model for use by diagnostic centres in choosing the most suitable strategy, on the basis of the local prevalence of PCP.