PMID: 9424980Jan 10, 1998Paper

Test-treatment strategies for patients suspected of having Lyme disease: a cost-effectiveness analysis

Annals of Internal Medicine
G NicholP Tugwell

Abstract

To examine the cost-effectiveness of test-treatment strategies for patients suspected of having Lyme disease. The medical literature was searched for information on outcomes and costs. Expert opinion was sought for information on utilities. Articles that described patient population, diagnostic criteria, dose and duration of therapy, and criteria for assessment of outcomes. The decision analysis evaluated the following strategies: 1) no testing-no treatment; 2) testing with enzyme-linked immunosorbent assay (ELISA) followed by antibiotic treatment of patients with positive results; 3) two-step testing with ELISA followed by Western blot and antibiotic treatment for patients with positive results on either test; and 4) empirical antibiotic therapy. Three patient scenarios were considered: myalgic symptoms, rash resembling erythema migrans, and recurrent oligoarticular inflammatory arthritis. Results were calculated as costs per quality-adjusted life-year and were subjected to sensitivity analysis. Adjustment was made for the diagnostic value of common clinical features of Lyme disease. For myalgic symptoms without other features suggestive of Lyme disease, the no testing-no treatment strategy was most economically attractive (th...Continue Reading

Citations

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