Document 0647
 DOCN  M9650647
 TI    Cost-analysis of four diagnostic strategies for Pneumocystis carinii
       pneumonia in HIV-infected subjects.
 DT    9605
 AU    Chouaid C; Housset B; Lebeau B; Service de Pneumologie, Hopital Saint
       Antoine, Paris, France.
 SO    Eur Respir J. 1995 Sep;8(9):1554-8. Unique Identifier : AIDSLINE
       MED/96120042
 AB    The aim of this study was to analyse the cost-effectiveness ratio of
       four diagnostic strategies for Pneumocystis carinii pneumonia (PCP) in
       patients infected with human immunodeficiency virus (HIV). Two hundred
       and ten HIV-infected patients with suspected PCP underwent
       induced-sputum (IS) followed, if negative, by bronchoalveolar lavage
       (BAL); 85 of these patients were able to undergo an exercise test (ET),
       prior to induced sputum and BAL. The following strategies were analysed:
       BAL strategy (BAL whenever PCP is suspected); IS strategy (induced
       sputum followed by BAL if negative); exercise test (ET) strategy, (ET
       followed by BAL if the results are abnormal); and the ES (exercise
       sputum) strategy (i.e. BAL only after abnormal ET and negative IS). The
       cost of each strategy was calculated by taking into account only direct
       costs; the conditions in which two given strategies would be
       cost-equivalent were also evaluated. The prevalence of PCP in this
       population was 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.
 DE    AIDS-Related Opportunistic Infections/*DIAGNOSIS  Bronchoalveolar
       Lavage/ECONOMICS/METHODS  Costs and Cost Analysis  Diagnosis,
       Laboratory/*ECONOMICS  Exercise Test/ECONOMICS/METHODS  France  Human
       Pneumonia, Pneumocystis carinii/*DIAGNOSIS  Prevalence  Respiratory
       Function Tests/*ECONOMICS  Sensitivity and Specificity
       Sputum/MICROBIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).