Abstract：
BACKGROUND:There is wide variation in the techniques deployed to diagnose tuberculosis in the UK, with little agreement on which tools or strategies are cost effective. This analysis therefore comprehensively evaluated the cost effectiveness of currently available diagnostic strategies for routine diagnosis of TB in the NHS. METHODS:The analysis compared strategies consisting of Nucleic Acid Amplification Techniques, culture and microscopy. A decision tree was used to estimate costs and Quality-Adjusted Life Years (QALYs) from a UK health service perspective. The sensitivity and specificity of each test determined the true and false positive and negative results in patients suspected of having active tuberculosis. These results led to either early, correct diagnosis or delayed diagnosis and the associated costs and QALYs. The presence of active tuberculosis combined with the side effects of treatment was associated with reduction in quality of life. Costs included were test costs, drug costs and the management of tuberculosis. Drug costs were based on generic UK list prices. Uncertainty in the model was explored through probabilistic and deterministic sensitivity analyses. RESULTS/CONCLUSIONS:The cost effective strategy at threshold of £20,000 per QALY was a strategy using only sputum microscopy and culture routinely, meaning Nucleic Acid Amplification Techniques are not cost effective at baseline. When the prevalence of tuberculosis was increased, however, nucleic acid amplification became cost effective at the same threshold. Aside from the prevalence, the results were shown to be robust. At low tuberculosis prevalence, Nucleic Acid Amplification Techniques may not be cost effective but their potential in higher prevalence situations is considerable.
journal_name
Respir Medjournal_title
Respiratory medicineauthors
Hughes R,Wonderling D,Li B,Higgins Bdoi
10.1016/j.rmed.2011.10.005subject
Has Abstractpub_date
2012-02-01 00:00:00pages
300-7issue
2eissn
0954-6111issn
1532-3064pii
S0954-6111(11)00345-3journal_volume
106pub_type
杂志文章,评审abstract：OBJECTIVE:Although high-resolution computed tomography (HRCT) is useful for the characterization of minute morphological changes in the lungs, no study has investigated risk factors for lung involvement detected by HRCT in patients with Sjögren's syndrome with or without respiratory symptoms. The aim of the current stu...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2018.02.023
更新日期：2018-04-01 00:00:00
abstract：BACKGROUND:Pulmonary alveolar proteinosis (PAP) is a rare syndrome characterized by the intra-alveolar accumulation of surfactant lipids and proteins. The aim of the study is to describe the epidemiologic, clinical, physiologic, and laboratory features of PAP in a large single-center cohort of patients with PAP. STUDY...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2011.08.018
更新日期：2011-12-01 00:00:00
abstract：INTRODUCTION:Polymerase chain reaction (PCR)-based techniques to detect Mycobacterium tuberculosis DNA in respiratory specimens have been increasingly used to diagnose pulmonary tuberculosis. Their use in non-respiratory specimens to diagnose extrapulmonary tuberculosis is, however, controversial. In this study, we est...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2014.04.007
更新日期：2014-06-01 00:00:00
abstract：INTRODUCTION:Combination inhaled corticosteroid/long-acting bronchodilator (ICS/LABA) therapy reduces the exacerbation rate and improves spirometry and quality of life in COPD. We hypothesized that ICS/LABA therapy also improves small airway function measured by FOT. METHODS:14 subjects with COPD were commenced on com...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2013.10.004
更新日期：2014-02-01 00:00:00
abstract：:Synovial sarcoma most commonly occurs in the peri-articular regions of the extremities. The present report describes a rare case of primary biphasic synovial sarcoma of the pleura in an 18-year-old female. The diagnosis was made on the basis of light microscopy, immunohistochemistry, electron microscopy and the charac...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/s0954-6111(97)90093-7
更新日期：1997-10-01 00:00:00
abstract：:Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition worldwide and is associated with significant mortality. This paper gives an overview of the relevant literature regarding care needs in advanced COPD from the perspective of the patient or carer, and aims to explore the appropriateness of a p...
journal_title：Respiratory medicine
pub_type： 杂志文章,评审
doi：10.1016/j.rmed.2009.09.007
更新日期：2010-02-01 00:00:00
abstract：:Epithelioid haemangioendothelioma of the pulmonary vessels is a rare neoplasm which usually has a minimal clinical expression. The present case report describes an exceptional case with severe inaugural alveolar haemorrhage which led to death by acute respiratory failure within a few weeks. ...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/s0954-6111(97)90077-9
更新日期：1997-02-01 00:00:00
abstract：BACKGROUND:Current evidence suggests that blood eosinophil levels (Eos) are associated with chronic obstructive pulmonary disease (COPD) treatment response and natural history. This analysis investigated the relationship between Eos levels and clinical characteristics in a representative cohort of US subjects with spir...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2016.01.013
更新日期：2016-03-01 00:00:00
abstract：:Malnutrition may be an extremely important complicating factor in patients with a variety of chronic lung diseases. The impact of malnutrition on lung disease and respiratory muscle function has been extensively studied in patients with chronic lung disease due to cystic fibrosis (CF). In patients with CF it appears t...
journal_title：Respiratory medicine
pub_type： 杂志文章,评审
doi：10.1016/0954-6111(93)90127-l
更新日期：1993-08-01 00:00:00
abstract：:In this economic evaluation, conducted alongside a randomized, double-blind clinical trial, economic data were collected from 339 patients with moderate-persistent asthma randomized to receive twice-daily, double-blind treatment with budesonide/formoterol 160/4.5 microg in a single inhaler (n=166) or fluticasone propi...
journal_title：Respiratory medicine
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1016/j.rmed.2005.09.032
更新日期：2006-04-01 00:00:00
abstract：RATIONALE:Infradiagnosis of chronic obstructive pulmonary disease (COPD) may be related to the lack of knowledge about the disease and/or the scarce use of diagnostic procedures. This study analyses the frequency of respiratory symptoms and the knowledge about COPD in the general population, together with the use of sp...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2006.02.024
更新日期：2006-11-01 00:00:00
abstract：BACKGROUND:Previous research has found conflictive results regarding the benefits of inspiratory muscle training (IMT) for cystic fibrosis (CF) patients. Also, involvement of postural stability is a rising concern in chronic lung diseases but its role in CF patients is poorly understood. Our aim was to investigate the ...
journal_title：Respiratory medicine
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.rmed.2019.01.013
更新日期：2019-03-01 00:00:00
abstract：BACKGROUND:During military service young men (age 19-21 years) are exposed to many predisposing factors for asthma. We aimed to study the short-term prognosis of asthma after the military service. METHODS:All 216 men with verified asthma in 2004-2005 from the register of the Central Military Hospital were included in ...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2009.05.022
更新日期：2009-12-01 00:00:00
abstract：BACKGROUND:The diagnosis of pulmonary aspergillosis is difficult because the sensitivity of the conventional methods for the detection of Aspergillus such as culture and cytology, is poor. To improve the sensitivity for Aspergillus detection, the detection of galactomannan antigen has been investigated. The serum galac...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2013.04.007
更新日期：2013-07-01 00:00:00
abstract：:We compare the adequacy of several titration procedures of oxygen flow in maintaining SpO(2) > 90% during the activities of daily life in patients with very severe COPD. Thirty-one very severe COPD patients undergoing oxygen-therapy were recruited. Three titration methods were randomly performed: (1) 6-min walking tes...
journal_title：Respiratory medicine
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.rmed.2012.06.021
更新日期：2012-11-01 00:00:00
abstract：:Clinically there are several different types of eosinophilic pneumonia (EP), but other than for tropical pulmonary eosinophilia, the humoral immune response between different types of EP, such as acute eosinophilic pneumonia (AEP), chronic EP, drug-induced EP, allergic bronchopulmonary aspergillosis, and Churg-Strauss...
journal_title：Respiratory medicine
pub_type： 杂志文章,多中心研究
doi：10.1016/j.rmed.2008.01.004
更新日期：2008-06-01 00:00:00
abstract：:There is a subclinical activation of coagulation and fibrinolysis system in lung cancer. Alterations in hemostatic system are seen frequently in lung cancer correlated with the prognosis of disease. In this prospective study, our purpose was to investigate the prognostic significance of hemostatic markers in patients ...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2003.07.001
更新日期：2004-02-01 00:00:00
abstract：:In developing countries, many sputum-negative suspects of pulmonary tuberculosis (PTB) are given antituberculous medication just because tuberculosis (TB) could not be excluded in them. Many studies have shown that BCG test is nearly 100% sensitive, except in those with severe malnutrition, steroid therapy and other c...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1053/rmed.2003.1478
更新日期：2003-05-01 00:00:00
abstract：:Lung cancer is the leading cause of cancer-related death worldwide with a 5-year survival rate of less than 15%, despite significant advances in both diagnostic and therapeutic approaches. Combined genomic and transcriptomic sequencing studies have identified numerous genetic driver mutations that are responsible for ...
journal_title：Respiratory medicine
pub_type： 杂志文章,评审
doi：10.1016/j.rmed.2015.10.006
更新日期：2016-01-01 00:00:00
abstract：:Ankylosing spondylitis (AS) is a chronic seronegative spondyloarthritis with the major histocompatibility antigen HLA B27. Pulmonary involvement in AS is rare and is usually in the form of upper lobe fibrocavitary disease. Herein, we present a case with recurrent pleural and pericardial effusion without apical fibrobu...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2006.04.028
更新日期：2007-02-01 00:00:00
abstract：BACKGROUND:We aimed to investigate the results of anti-tumor necrosis factor (TNF) therapy in patients with a previous history of tuberculosis (TB). METHODS:A total of 101 patients with a previous history of TB receiving TNF antagonists between December 2004 and September 2012 at the Asan Medical Center in South Korea...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2013.08.011
更新日期：2013-11-01 00:00:00
abstract：BACKGROUND:The aim of the study was to investigate the efficacy and safety of ciclesonide compared with budesonide in adolescents with severe asthma. METHODS:In this randomized, double-blind, double-dummy, parallel-group study, patients aged 12-17 years with severe asthma were treated with budesonide 400 microg once d...
journal_title：Respiratory medicine
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1016/j.rmed.2007.05.006
更新日期：2007-10-01 00:00:00
abstract：BACKGROUND:Smoking continues to be a major risk factor for COPD and may impact the efficacy of COPD treatments, with guidelines supporting the crucial importance for current smokers of smoking cessation. A post-hoc analysis of the FLIGHT1 and FLIGHT2 studies assessed the impact of smoking status on the efficacy and saf...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2019.07.019
更新日期：2019-08-01 00:00:00
abstract：:Hypoxemic patients with chronic obstructive pulmonary disease (COPD) are at risk of carbon dioxide (CO(2)) retention during oxygen therapy and hypercapnia in COPD is associated with an ominous prognosis. Rebreathing with oxygen mask is possible in practice and possibly affects CO(2) retention due to an increased inspi...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2008.08.015
更新日期：2008-12-01 00:00:00
abstract：BACKGROUND/OBJECTIVES:It has been reported that adverse fetal outcomes are more prevalent in pregnant women with asthma than they are in women without asthma. In our study, we investigated the effect that the severity of asthma during pregnancy has on the risk of a small for gestational age (SGA) infant, low birth weig...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2010.03.010
更新日期：2010-09-01 00:00:00
abstract：:Cyclosporin A (CsA) is an immunomodulator drug that has been used in the treatment of several types of advanced pulmonary interstitial disease. This beneficial effect occurs mainly in circumstances in which alveolitis due to CD4 lymphocytes is absent, suggesting that CsA acts on other types of cells. The present study...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/s0954-6111(98)90002-6
更新日期：1998-05-01 00:00:00
abstract：:Ten patients (two male) suffering from acute exacerbations of long-standing chronic obstructive pulmonary disease and admitted in hypoxic, hypercapnic respiratory failure were treated with Nasal Intermittent Positive Pressure Ventilation (NIPPV) plus supplemental oxygen, on a general medical ward. The median (range) p...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/0954-6111(93)90054-4
更新日期：1993-07-01 00:00:00
abstract：:A 56-year-old female patient, developing ALK-negative anaplastic T cell lymphoma 7 years after the diagnosis of sarcoidosis with clinical and histopathological features of tuberculosis has been presented. We herein present concurrent occurrence of the sarcoidosis, lymphoma and tuberculosis along with the confusing fin...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2005.09.001
更新日期：2006-05-01 00:00:00
abstract：BACKGROUND:Respiratory complaints after exercise are common in patients with rhinitis. Exercise-induced bronchospasm (EIB) may be one of the causes. OBJECTIVES:To evaluate EIB prevalence in a group of children and adolescents with allergic rhinitis, to compare the treadmill running (TR) and eucapnic voluntary hyperven...
journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1016/j.rmed.2018.04.001
更新日期：2018-05-01 00:00:00
abstract：:Long-acting bronchodilators in combination with inhaled corticosteroids (ICS) are recommended to decrease the risk of recurrent exacerbations in patients with Global initiative for chronic Obstructive Lung Disease (GOLD) stage 3-4 chronic obstructive pulmonary disease (COPD). There is increasing concern about the clin...
journal_title：Respiratory medicine
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1016/j.rmed.2014.01.002
更新日期：2014-04-01 00:00:00
