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Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.

dc.contributor.author Chu, Vivian Hou
dc.contributor.author Fowler, Vance Garrison Jr
dc.contributor.author Ginsburg, Geoffrey Steven
dc.contributor.author Glickman, Seth W
dc.contributor.author Himmel, T
dc.contributor.author Hudson, LL
dc.contributor.author Katz, JN
dc.contributor.author Li, Y
dc.contributor.author Limkakeng, Alexander
dc.contributor.author McClain, MT
dc.contributor.author Reed, Shelby Derene
dc.contributor.author Tsalik, Ephraim L
dc.contributor.author Welty-Wolf, KE
dc.contributor.author Woods, Christopher Wildrick
dc.coverage.spatial United States
dc.date.accessioned 2016-08-01T14:29:29Z
dc.date.issued 2016-03
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/26700878
dc.identifier.uri http://hdl.handle.net/10161/12538
dc.description.abstract 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.
dc.language eng
dc.relation.ispartof Ann Am Thorac Soc
dc.relation.isversionof 10.1513/AnnalsATS.201504-205OC
dc.subject cost-benefit analysis
dc.subject cross infection
dc.subject early diagnosis
dc.subject ventilator-associated pneumonia
dc.subject Adult
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Cost-Benefit Analysis
dc.subject Critical Illness
dc.subject Cross Infection
dc.subject Decision Support Techniques
dc.subject Early Diagnosis
dc.subject Female
dc.subject Humans
dc.subject Male
dc.subject Middle Aged
dc.subject North Carolina
dc.subject Pneumonia, Ventilator-Associated
dc.subject Prospective Studies
dc.subject Quality-Adjusted Life Years
dc.subject Young Adult
dc.title Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/26700878
pubs.begin-page 401
pubs.end-page 413
pubs.issue 3
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biomedical Engineering
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Global Health Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group Medicine, Infectious Diseases
pubs.organisational-group Medicine, Pulmonary, Allergy, and Critical Care Medicine
pubs.organisational-group Molecular Genetics and Microbiology
pubs.organisational-group Pathology
pubs.organisational-group Pratt School of Engineering
pubs.organisational-group School of Medicine
pubs.organisational-group School of Nursing
pubs.organisational-group School of Nursing - Secondary Group
pubs.organisational-group Surgery
pubs.organisational-group Surgery, Emergency Medicine
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published
pubs.volume 13
dc.identifier.eissn 2325-6621


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