Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings
High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases. We developed a decision analytic model to project quali...
Gespeichert in:
| Veröffentlicht in: | Clinical infectious diseases 2018-01, Vol.66 (3), p.376-384 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 384 |
|---|---|
| container_issue | 3 |
| container_start_page | 376 |
| container_title | Clinical infectious diseases |
| container_volume | 66 |
| creator | Assoumou, Sabrina A Tasillo, Abriana Leff, Jared A Schackman, Bruce R Drainoni, Mari-Lynn Horsburgh, C Robert Barry, M Anita Regis, Craig Kim, Arthur Y Marshall, Alison Saxena, Sheel Smith, Peter C Linas, Benjamin P |
| description | High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases.
We developed a decision analytic model to project quality-adjusted life years (QALYs), costs (2016 US$), and incremental cost-effectiveness ratios (ICERs) of 9 strategies for 1-time testing among 15- to 30-year-olds seen at urban community health centers. Strategies differed in 3 ways: targeted vs routine testing, rapid finger stick vs standard venipuncture, and ordered by physician vs by counselor/tester using standing orders. We performed deterministic and probabilistic sensitivity analyses (PSA) to evaluate uncertainty.
Compared to targeted risk-based testing (current standard of care), routine testing increased the lifetime medical cost by $80 and discounted QALYs by 0.0013 per person. Across all strategies, rapid testing provided higher QALYs at a lower cost per QALY gained and was always preferred. Counselor-initiated routine rapid testing was associated with an ICER of $71000/QALY gained. Results were sensitive to offer and result receipt rates. Counselor-initiated routine rapid testing was cost-effective (ICER |
| doi_str_mv | 10.1093/cid/cix798 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5848253</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2007092702</sourcerecordid><originalsourceid>FETCH-LOGICAL-c406t-4b2674ef0578540aeffba94d7e2b794c40597be10293eada1aebda3f037ec4043</originalsourceid><addsrcrecordid>eNpVkV9rFDEUxYMotlZf_AAS8E0Yvfm3mbwIy1CtUKiw9cGnkJm5WVN2kzXJFMUvb-rWog-XXM79cXLgEPKSwVsGRrybwtzmhzb9I3LKlNDdShn2uO2g-k72oj8hz0q5AWCsB_WUnHADHATTp-TXkErtzr3HqYZbjFgKTZ5eReyuwx7pBR5cDTUUOtDNlBFjiFu6qdlV3AYsdL1PTVjPaYdlwlgLdXGmX9PyR112TQiRfs5h7_JPOriMdIO1NpfynDzxblfwxf17Rr58OL8eLrrLq4-fhvVlN0lY1U6OfKUlelC6VxIcej86I2eNfNRGNkgZPSIDbgS62TGH4-yEB6GxHaU4I--Pvodl3ON8lzK7nT0cM9nkgv3_EsM3u023VvWy50o0g9f3Bjl9X7BUe5OWHFtmywE0GK6BN-rNkZpyKiWjf_iBgb0ryrai7LGoBr_6N9MD-rcZ8RvQsZH-</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2007092702</pqid></control><display><type>article</type><title>Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>JSTOR Archive Collection A-Z Listing</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Assoumou, Sabrina A ; Tasillo, Abriana ; Leff, Jared A ; Schackman, Bruce R ; Drainoni, Mari-Lynn ; Horsburgh, C Robert ; Barry, M Anita ; Regis, Craig ; Kim, Arthur Y ; Marshall, Alison ; Saxena, Sheel ; Smith, Peter C ; Linas, Benjamin P</creator><creatorcontrib>Assoumou, Sabrina A ; Tasillo, Abriana ; Leff, Jared A ; Schackman, Bruce R ; Drainoni, Mari-Lynn ; Horsburgh, C Robert ; Barry, M Anita ; Regis, Craig ; Kim, Arthur Y ; Marshall, Alison ; Saxena, Sheel ; Smith, Peter C ; Linas, Benjamin P</creatorcontrib><description>High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases.
We developed a decision analytic model to project quality-adjusted life years (QALYs), costs (2016 US$), and incremental cost-effectiveness ratios (ICERs) of 9 strategies for 1-time testing among 15- to 30-year-olds seen at urban community health centers. Strategies differed in 3 ways: targeted vs routine testing, rapid finger stick vs standard venipuncture, and ordered by physician vs by counselor/tester using standing orders. We performed deterministic and probabilistic sensitivity analyses (PSA) to evaluate uncertainty.
Compared to targeted risk-based testing (current standard of care), routine testing increased the lifetime medical cost by $80 and discounted QALYs by 0.0013 per person. Across all strategies, rapid testing provided higher QALYs at a lower cost per QALY gained and was always preferred. Counselor-initiated routine rapid testing was associated with an ICER of $71000/QALY gained. Results were sensitive to offer and result receipt rates. Counselor-initiated routine rapid testing was cost-effective (ICER <$100000/QALY) unless the prevalence of PWID was <0.59%, HCV prevalence among PWID was <16%, reinfection rate was >26 cases per 100 person-years, or reflex confirmatory testing followed all reactive venipuncture diagnostics. In PSA, routine rapid testing was the optimal strategy in 90% of simulations.
Routine rapid HCV testing among 15- to 30-year-olds may be cost-effective when the prevalence of PWID is >0.59%.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/cix798</identifier><identifier>PMID: 29020317</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adolescent ; Adolescents ; Adult ; Adults ; and Commentaries ; Computer Simulation ; Cost analysis ; Cost-Benefit Analysis ; Decision analysis ; Diagnostic Screening Programs - economics ; Drug development ; Female ; Health care ; Hepacivirus - isolation & purification ; Hepatitis ; Hepatitis C ; Hepatitis C, Chronic - diagnosis ; Hepatitis C, Chronic - economics ; Humans ; Male ; Mathematical models ; Medical screening ; Primary care ; Primary Health Care - economics ; Quality of Life ; Quality-Adjusted Life Years ; Sensitivity analysis ; Substance Abuse, Intravenous - complications ; Substance Abuse, Intravenous - virology ; Teenagers ; Urban areas ; Urban Health Services - statistics & numerical data ; Viruses ; Young Adult ; Young adults</subject><ispartof>Clinical infectious diseases, 2018-01, Vol.66 (3), p.376-384</ispartof><rights>The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><rights>Copyright Oxford University Press, UK Feb 1, 2018</rights><rights>The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c406t-4b2674ef0578540aeffba94d7e2b794c40597be10293eada1aebda3f037ec4043</citedby><cites>FETCH-LOGICAL-c406t-4b2674ef0578540aeffba94d7e2b794c40597be10293eada1aebda3f037ec4043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29020317$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Assoumou, Sabrina A</creatorcontrib><creatorcontrib>Tasillo, Abriana</creatorcontrib><creatorcontrib>Leff, Jared A</creatorcontrib><creatorcontrib>Schackman, Bruce R</creatorcontrib><creatorcontrib>Drainoni, Mari-Lynn</creatorcontrib><creatorcontrib>Horsburgh, C Robert</creatorcontrib><creatorcontrib>Barry, M Anita</creatorcontrib><creatorcontrib>Regis, Craig</creatorcontrib><creatorcontrib>Kim, Arthur Y</creatorcontrib><creatorcontrib>Marshall, Alison</creatorcontrib><creatorcontrib>Saxena, Sheel</creatorcontrib><creatorcontrib>Smith, Peter C</creatorcontrib><creatorcontrib>Linas, Benjamin P</creatorcontrib><title>Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases.
We developed a decision analytic model to project quality-adjusted life years (QALYs), costs (2016 US$), and incremental cost-effectiveness ratios (ICERs) of 9 strategies for 1-time testing among 15- to 30-year-olds seen at urban community health centers. Strategies differed in 3 ways: targeted vs routine testing, rapid finger stick vs standard venipuncture, and ordered by physician vs by counselor/tester using standing orders. We performed deterministic and probabilistic sensitivity analyses (PSA) to evaluate uncertainty.
Compared to targeted risk-based testing (current standard of care), routine testing increased the lifetime medical cost by $80 and discounted QALYs by 0.0013 per person. Across all strategies, rapid testing provided higher QALYs at a lower cost per QALY gained and was always preferred. Counselor-initiated routine rapid testing was associated with an ICER of $71000/QALY gained. Results were sensitive to offer and result receipt rates. Counselor-initiated routine rapid testing was cost-effective (ICER <$100000/QALY) unless the prevalence of PWID was <0.59%, HCV prevalence among PWID was <16%, reinfection rate was >26 cases per 100 person-years, or reflex confirmatory testing followed all reactive venipuncture diagnostics. In PSA, routine rapid testing was the optimal strategy in 90% of simulations.
Routine rapid HCV testing among 15- to 30-year-olds may be cost-effective when the prevalence of PWID is >0.59%.</description><subject>Adolescent</subject><subject>Adolescents</subject><subject>Adult</subject><subject>Adults</subject><subject>and Commentaries</subject><subject>Computer Simulation</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Decision analysis</subject><subject>Diagnostic Screening Programs - economics</subject><subject>Drug development</subject><subject>Female</subject><subject>Health care</subject><subject>Hepacivirus - isolation & purification</subject><subject>Hepatitis</subject><subject>Hepatitis C</subject><subject>Hepatitis C, Chronic - diagnosis</subject><subject>Hepatitis C, Chronic - economics</subject><subject>Humans</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medical screening</subject><subject>Primary care</subject><subject>Primary Health Care - economics</subject><subject>Quality of Life</subject><subject>Quality-Adjusted Life Years</subject><subject>Sensitivity analysis</subject><subject>Substance Abuse, Intravenous - complications</subject><subject>Substance Abuse, Intravenous - virology</subject><subject>Teenagers</subject><subject>Urban areas</subject><subject>Urban Health Services - statistics & numerical data</subject><subject>Viruses</subject><subject>Young Adult</subject><subject>Young adults</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkV9rFDEUxYMotlZf_AAS8E0Yvfm3mbwIy1CtUKiw9cGnkJm5WVN2kzXJFMUvb-rWog-XXM79cXLgEPKSwVsGRrybwtzmhzb9I3LKlNDdShn2uO2g-k72oj8hz0q5AWCsB_WUnHADHATTp-TXkErtzr3HqYZbjFgKTZ5eReyuwx7pBR5cDTUUOtDNlBFjiFu6qdlV3AYsdL1PTVjPaYdlwlgLdXGmX9PyR112TQiRfs5h7_JPOriMdIO1NpfynDzxblfwxf17Rr58OL8eLrrLq4-fhvVlN0lY1U6OfKUlelC6VxIcej86I2eNfNRGNkgZPSIDbgS62TGH4-yEB6GxHaU4I--Pvodl3ON8lzK7nT0cM9nkgv3_EsM3u023VvWy50o0g9f3Bjl9X7BUe5OWHFtmywE0GK6BN-rNkZpyKiWjf_iBgb0ryrai7LGoBr_6N9MD-rcZ8RvQsZH-</recordid><startdate>20180118</startdate><enddate>20180118</enddate><creator>Assoumou, Sabrina A</creator><creator>Tasillo, Abriana</creator><creator>Leff, Jared A</creator><creator>Schackman, Bruce R</creator><creator>Drainoni, Mari-Lynn</creator><creator>Horsburgh, C Robert</creator><creator>Barry, M Anita</creator><creator>Regis, Craig</creator><creator>Kim, Arthur Y</creator><creator>Marshall, Alison</creator><creator>Saxena, Sheel</creator><creator>Smith, Peter C</creator><creator>Linas, Benjamin P</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>5PM</scope></search><sort><creationdate>20180118</creationdate><title>Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings</title><author>Assoumou, Sabrina A ; Tasillo, Abriana ; Leff, Jared A ; Schackman, Bruce R ; Drainoni, Mari-Lynn ; Horsburgh, C Robert ; Barry, M Anita ; Regis, Craig ; Kim, Arthur Y ; Marshall, Alison ; Saxena, Sheel ; Smith, Peter C ; Linas, Benjamin P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-4b2674ef0578540aeffba94d7e2b794c40597be10293eada1aebda3f037ec4043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adolescents</topic><topic>Adult</topic><topic>Adults</topic><topic>and Commentaries</topic><topic>Computer Simulation</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Decision analysis</topic><topic>Diagnostic Screening Programs - economics</topic><topic>Drug development</topic><topic>Female</topic><topic>Health care</topic><topic>Hepacivirus - isolation & purification</topic><topic>Hepatitis</topic><topic>Hepatitis C</topic><topic>Hepatitis C, Chronic - diagnosis</topic><topic>Hepatitis C, Chronic - economics</topic><topic>Humans</topic><topic>Male</topic><topic>Mathematical models</topic><topic>Medical screening</topic><topic>Primary care</topic><topic>Primary Health Care - economics</topic><topic>Quality of Life</topic><topic>Quality-Adjusted Life Years</topic><topic>Sensitivity analysis</topic><topic>Substance Abuse, Intravenous - complications</topic><topic>Substance Abuse, Intravenous - virology</topic><topic>Teenagers</topic><topic>Urban areas</topic><topic>Urban Health Services - statistics & numerical data</topic><topic>Viruses</topic><topic>Young Adult</topic><topic>Young adults</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Assoumou, Sabrina A</creatorcontrib><creatorcontrib>Tasillo, Abriana</creatorcontrib><creatorcontrib>Leff, Jared A</creatorcontrib><creatorcontrib>Schackman, Bruce R</creatorcontrib><creatorcontrib>Drainoni, Mari-Lynn</creatorcontrib><creatorcontrib>Horsburgh, C Robert</creatorcontrib><creatorcontrib>Barry, M Anita</creatorcontrib><creatorcontrib>Regis, Craig</creatorcontrib><creatorcontrib>Kim, Arthur Y</creatorcontrib><creatorcontrib>Marshall, Alison</creatorcontrib><creatorcontrib>Saxena, Sheel</creatorcontrib><creatorcontrib>Smith, Peter C</creatorcontrib><creatorcontrib>Linas, Benjamin P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Assoumou, Sabrina A</au><au>Tasillo, Abriana</au><au>Leff, Jared A</au><au>Schackman, Bruce R</au><au>Drainoni, Mari-Lynn</au><au>Horsburgh, C Robert</au><au>Barry, M Anita</au><au>Regis, Craig</au><au>Kim, Arthur Y</au><au>Marshall, Alison</au><au>Saxena, Sheel</au><au>Smith, Peter C</au><au>Linas, Benjamin P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2018-01-18</date><risdate>2018</risdate><volume>66</volume><issue>3</issue><spage>376</spage><epage>384</epage><pages>376-384</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases.
We developed a decision analytic model to project quality-adjusted life years (QALYs), costs (2016 US$), and incremental cost-effectiveness ratios (ICERs) of 9 strategies for 1-time testing among 15- to 30-year-olds seen at urban community health centers. Strategies differed in 3 ways: targeted vs routine testing, rapid finger stick vs standard venipuncture, and ordered by physician vs by counselor/tester using standing orders. We performed deterministic and probabilistic sensitivity analyses (PSA) to evaluate uncertainty.
Compared to targeted risk-based testing (current standard of care), routine testing increased the lifetime medical cost by $80 and discounted QALYs by 0.0013 per person. Across all strategies, rapid testing provided higher QALYs at a lower cost per QALY gained and was always preferred. Counselor-initiated routine rapid testing was associated with an ICER of $71000/QALY gained. Results were sensitive to offer and result receipt rates. Counselor-initiated routine rapid testing was cost-effective (ICER <$100000/QALY) unless the prevalence of PWID was <0.59%, HCV prevalence among PWID was <16%, reinfection rate was >26 cases per 100 person-years, or reflex confirmatory testing followed all reactive venipuncture diagnostics. In PSA, routine rapid testing was the optimal strategy in 90% of simulations.
Routine rapid HCV testing among 15- to 30-year-olds may be cost-effective when the prevalence of PWID is >0.59%.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>29020317</pmid><doi>10.1093/cid/cix798</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1058-4838 |
| ispartof | Clinical infectious diseases, 2018-01, Vol.66 (3), p.376-384 |
| issn | 1058-4838 1537-6591 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5848253 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; JSTOR Archive Collection A-Z Listing; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adolescent Adolescents Adult Adults and Commentaries Computer Simulation Cost analysis Cost-Benefit Analysis Decision analysis Diagnostic Screening Programs - economics Drug development Female Health care Hepacivirus - isolation & purification Hepatitis Hepatitis C Hepatitis C, Chronic - diagnosis Hepatitis C, Chronic - economics Humans Male Mathematical models Medical screening Primary care Primary Health Care - economics Quality of Life Quality-Adjusted Life Years Sensitivity analysis Substance Abuse, Intravenous - complications Substance Abuse, Intravenous - virology Teenagers Urban areas Urban Health Services - statistics & numerical data Viruses Young Adult Young adults |
| title | Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-13T10%3A13%3A51IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Cost-Effectiveness%20of%20One-Time%20Hepatitis%20C%20Screening%20Strategies%20Among%20Adolescents%20and%20Young%20Adults%20in%20Primary%20Care%20Settings&rft.jtitle=Clinical%20infectious%20diseases&rft.au=Assoumou,%20Sabrina%20A&rft.date=2018-01-18&rft.volume=66&rft.issue=3&rft.spage=376&rft.epage=384&rft.pages=376-384&rft.issn=1058-4838&rft.eissn=1537-6591&rft_id=info:doi/10.1093/cid/cix798&rft_dat=%3Cproquest_pubme%3E2007092702%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2007092702&rft_id=info:pmid/29020317&rfr_iscdi=true |