Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.
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RATIONALE: Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these infections. OBJECTIVES: We developed a decision modeling framework to assess the potential cost-effectiveness of a rapid biomarker assay to identify hospital-acquired infection in high-risk patients earlier than standard diagnostic testing. METHODS: The framework includes parameters representing rates of infection, rates of delayed appropriate therapy, and impact of delayed therapy on mortality, along with assumptions about diagnostic test characteristics and their impact on delayed therapy and length of stay. Parameter estimates were based on contemporary, published studies and supplemented with data from a four-site, observational, clinical study. Extensive sensitivity analyses were performed. The base-case analysis assumed 17.6% of ventilated patients and 11.2% of nonventilated patients develop hospital-acquired infection and that 28.7% of patients with hospital-acquired infection experience delays in appropriate antibiotic therapy with standard care. We assumed this percentage decreased by 50% (to 14.4%) among patients with true-positive results and increased by 50% (to 43.1%) among patients with false-negative results using a hypothetical biomarker assay. Cost of testing was set at $110/d. MEASUREMENTS AND MAIN RESULTS: In the base-case analysis, among ventilated patients, daily diagnostic testing starting on admission reduced inpatient mortality from 12.3 to 11.9% and increased mean costs by $1,640 per patient, resulting in an incremental cost-effectiveness ratio of $21,389 per life-year saved. Among nonventilated patients, inpatient mortality decreased from 7.3 to 7.1% and costs increased by $1,381 with diagnostic testing. The resulting incremental cost-effectiveness ratio was $42,325 per life-year saved. Threshold analyses revealed the probabilities of developing hospital-acquired infection in ventilated and nonventilated patients could be as low as 8.4 and 9.8%, respectively, to maintain incremental cost-effectiveness ratios less than $50,000 per life-year saved. CONCLUSIONS: Development and use of serial diagnostic testing that reduces the proportion of patients with delays in appropriate antibiotic therapy for hospital-acquired infections could reduce inpatient mortality. The model presented here offers a cost-effectiveness framework for future test development.
Aged, 80 and over
Decision Support Techniques
Quality-Adjusted Life Years
Published Version (Please cite this version)10.1513/AnnalsATS.201504-205OC
Publication InfoChu, Vivian Hou; Fowler, Vance Garrison Jr; Ginsburg, Geoffrey Steven; Glickman, Seth W; Himmel, T; Hudson, LL; ... Woods, Christopher Wildrick (2016). Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients. Ann Am Thorac Soc, 13(3). pp. 401-413. 10.1513/AnnalsATS.201504-205OC. Retrieved from http://hdl.handle.net/10161/12538.
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Dr. Chu's clinical research is focused on staphylococci and endocarditis (IE). She is the director of the International Collaboration on Endocarditis (ICE), a group of investigators from 78 sites in 32 countries worldwide that is dedicated to further the understanding of infective endocarditis. The ICE database comprises > 5000 cases of endocarditis and is designed to answer questions that could not be answered from a single-center study. The current focus of this group is surgica
Professor of Medicine
Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia Pathogenesis of Bacterial Infections Infections due to Resistant Gram Positive Organisms Tropical medicine/International Health
Professor of Medicine
Dr. Geoffrey S. Ginsburg's research interests are in the development of novel paradigms for developing and translating genomic information into medical practice and the integration of personalized medicine into health care.
Associate Professor of Surgery
My personal research interest is finding new ways to diagnose acute coronary syndrome. In particular, I am interested in novel biomarkers and precision medicine approaches to this problem. As Vice Chief of Research for the Duke Division of Emergency Medicine, I also work with researchers from many fields spanning global health, innovation, clinical trials, basic discovery and translational research. The common element is time-sensitive health conditions. I help
Professor in Population Health Sciences
Shelby D. Reed, PhD, is a professor in medicine at the Duke University School of Medicine. She works primarily at the Duke Clinical Research Institute. Dr. Reed holds a PhD in pharmaceutical health services research from the University of Maryland School of Pharmacy and completed a 2-year postdoctoral fellowship in the Pharmaceutical Outcomes Research and Policy Program and the Center for AIDS Research at the University of Washington. Dr. Reed has nearly 20 years of experience in economic e
Associate Professor of Medicine
My research is focused on understanding the dynamic between host and pathogen so as to discover and develop host-response markers that can diagnose and predict health and disease. This new and evolving approach to diagnosing illness has the potential to significantly impact individual as well as public health considering the rise of antibiotic resistance. With any potential infectious disease diagnosis, it is difficult, if not impossible, to determine at the time of presentation
Professor of Medicine
1. Emerging Infections 2. Global Health 3. Epidemiology of infectious diseases 4. Clinical microbiology and diagnostics 5. Bioterrorism Preparedness 6. Surveillance for communicable diseases 7. Antimicrobial resistance
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