PDF(Pubmed)
Abstract：
OBJECTIVE: To assess the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers.
METHODS: This study analyzes the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. The sensitivity and specificity, false positive, and negative results of the tests are extracted from diagnostic kits used in the laboratories of the target community. To accurately infer the results, a simulation based on 1000 people was used through 22 standard laboratory tests (Additional File 2), including calcium, oxalate, phosphate, uric acid, sulfate, potassium, sodium, citrate, and magnesium in 24-hour urine; and calcium, creatinine, Vit D, uric acid, and intact parathyroid hormone (PTH) in serum. The incremental cost-effectiveness ratio (ICER) was calculated and compared for each diagnostic test versus other diagnostic tests according to the incremental cost required for correct diagnoses of stone causes.
RESULTS: Urinary uric acid, citrate, and serum potassium constitute the cost-effectiveness boundary curve in this study. This means that other diagnostic tests are not cost-effective compared to these three tests in terms of indexing at least one item of cost and effectiveness. The ICER index for each correct diagnosis with the urinary uric acid test was $ 1.25 per diagnosis, the most cost-effective test compared to serum potassium and urinary citrate.
CONCLUSIONS: The simplified blood and 24-hour urine metabolic evaluation, including urinary uric acid, citrate, and serum potassium, constitute the cost-effectiveness boundary curve. The most cost-effective test was urinary uric acid measurement.
METHODS: This study analyzes the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. The sensitivity and specificity, false positive, and negative results of the tests are extracted from diagnostic kits used in the laboratories of the target community. To accurately infer the results, a simulation based on 1000 people was used through 22 standard laboratory tests (Additional File 2), including calcium, oxalate, phosphate, uric acid, sulfate, potassium, sodium, citrate, and magnesium in 24-hour urine; and calcium, creatinine, Vit D, uric acid, and intact parathyroid hormone (PTH) in serum. The incremental cost-effectiveness ratio (ICER) was calculated and compared for each diagnostic test versus other diagnostic tests according to the incremental cost required for correct diagnoses of stone causes.
RESULTS: Urinary uric acid, citrate, and serum potassium constitute the cost-effectiveness boundary curve in this study. This means that other diagnostic tests are not cost-effective compared to these three tests in terms of indexing at least one item of cost and effectiveness. The ICER index for each correct diagnosis with the urinary uric acid test was $ 1.25 per diagnosis, the most cost-effective test compared to serum potassium and urinary citrate.
CONCLUSIONS: The simplified blood and 24-hour urine metabolic evaluation, including urinary uric acid, citrate, and serum potassium, constitute the cost-effectiveness boundary curve. The most cost-effective test was urinary uric acid measurement.
摘要：
目的：评估常规血清和24小时尿检对肾结石患者基线代谢异常的诊断能力。
方法：本研究分析了常规血清和24小时尿液测试在诊断肾结石患者基线代谢异常方面的熟练程度。敏感性和特异性，假阳性,测试的阴性结果是从目标社区实验室使用的诊断试剂盒中提取的。为了准确推断结果，通过22项标准实验室测试使用了基于1000人的模拟(附加文件2)，包括钙,草酸盐,磷酸盐,尿酸,硫酸盐,钾，钠,柠檬酸盐24小时尿液中的镁和钙，肌酐,维生素D,尿酸,和血清中完整的甲状旁腺激素（PTH）。根据正确诊断结石原因所需的增量成本，计算并比较每种诊断测试与其他诊断测试的增量成本效益比（ICER）。
结果：尿尿酸，柠檬酸盐和血清钾构成本研究的成本-效果边界曲线。这意味着在索引至少一项成本和有效性方面，其他诊断测试与这三种测试相比并不具有成本效益。尿尿酸测试的每一次正确诊断的ICER指数为每次诊断$1.25,与血清钾和尿柠檬酸盐相比，最具成本效益的测试。
结论：简化的血液和24小时尿液代谢评估，包括尿尿酸,柠檬酸盐和血清钾，构成成本效益边界曲线。最具成本效益的测试是尿尿酸测量。
方法：本研究分析了常规血清和24小时尿液测试在诊断肾结石患者基线代谢异常方面的熟练程度。敏感性和特异性，假阳性,测试的阴性结果是从目标社区实验室使用的诊断试剂盒中提取的。为了准确推断结果，通过22项标准实验室测试使用了基于1000人的模拟(附加文件2)，包括钙,草酸盐,磷酸盐,尿酸,硫酸盐,钾，钠,柠檬酸盐24小时尿液中的镁和钙，肌酐,维生素D,尿酸,和血清中完整的甲状旁腺激素（PTH）。根据正确诊断结石原因所需的增量成本，计算并比较每种诊断测试与其他诊断测试的增量成本效益比（ICER）。
结果：尿尿酸，柠檬酸盐和血清钾构成本研究的成本-效果边界曲线。这意味着在索引至少一项成本和有效性方面，其他诊断测试与这三种测试相比并不具有成本效益。尿尿酸测试的每一次正确诊断的ICER指数为每次诊断$1.25,与血清钾和尿柠檬酸盐相比，最具成本效益的测试。
结论：简化的血液和24小时尿液代谢评估，包括尿尿酸,柠檬酸盐和血清钾，构成成本效益边界曲线。最具成本效益的测试是尿尿酸测量。
