scholarly journals Cost-Effective Respiratory Virus Testing

2019 ◽  
Vol 57 (9) ◽  
Author(s):  
B. A. Pinsky ◽  
R. T. Hayden
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Influenza A ◽  
Respiratory Virus ◽  
Cost Effective ◽  
Nucleic Acid Amplification ◽  
Virus Infections ◽  
The Cost ◽  
Respiratory Virus Infections ◽  
Virus Testing

ABSTRACTThe timely and accurate diagnosis of respiratory virus infections has the potential to optimize downstream (posttesting) use of limited health care resources, including antibiotics, antivirals, ancillary testing, and inpatient and emergency department beds. Cost-effective algorithms for respiratory virus testing must take into consideration numerous factors, including which patients should be tested, what testing should be performed (for example, antigen testing versus reverse transcription-PCR testing or influenza A/B testing versus testing with a comprehensive respiratory virus panel), and the turnaround time necessary to achieve the desired posttesting outcomes. Despite the clinical impact of respiratory virus infections, the cost-effectiveness of respiratory virus testing is incompletely understood. In this article, we review the literature pertaining to the cost-effectiveness of respiratory virus testing in pediatric and adult patient populations, in emergency department, outpatient, and inpatient clinical settings. Furthermore, we consider the cost-effectiveness of a variety of testing methods, including rapid antigen tests, direct fluorescent antibody assays, and nucleic acid amplification tests.

scholarly journals Cost-Effectiveness of Initial Revision Digit Amputation Performed in the Emergency Department Versus the Operating Room

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Joseph A. Gil ◽  
Avi D. Goodman ◽  
Andrew P. Harris ◽  
Neill Y. Li ◽  
Arnold-Peter C. Weiss
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Operating Room ◽  
Cost Effective ◽  
Initial Management ◽  
Fingertip Amputation ◽  
Significant Difference ◽  
Initial Procedure ◽  
The Cost ◽  
Cost Effectiveness Threshold

Background: The objective of this study was to determine the comparative cost-effectiveness of performing initial revision finger amputation in the emergency department (ED) versus in the operating room (OR) accounting for need for unplanned secondary revision in the OR. Methods: We retrospectively examined patients presenting to the ED with traumatic finger and thumb amputations from January 2010 to December 2015. Only those treated with primarily revision amputation were included. Following initial management, the need for unplanned reoperation was assessed and associated with setting of initial management. A sensitivity analysis was used to determine the cost-effectiveness threshold for initial management in the ED versus the OR. Results: Five hundred thirty-seven patients had 677 fingertip amputations, of whom 91 digits were initially primarily revised in the OR, and 586 digits were primarily revised in the ED. Following initial revision, 91 digits required unplanned secondary revision. The unplanned secondary revision rates were similar between settings: 13.7% digits from the ED and 12.1% of digits from the OR ( P = .57). When accounting for direct costs, an incidence of unplanned revision above 77.0% after initial revision fingertip amputation in the ED would make initial revision fingertip amputation in the OR cost-effective. Therefore, based on the unplanned secondary revision rate, initial management in the ED is more cost-effective than in the OR. Conclusions: There is no significant difference in the incidence of unplanned/secondary revision of fingertip amputation rate after the initial procedure was performed in the ED versus the OR.

scholarly journals Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

CJEM ◽  
2015 ◽  
Vol 18 (3) ◽  
pp. 191-204 ◽  
Author(s):  
Ivy Cheng ◽  
Maaret Castren ◽  
Alex Kiss ◽  
Merrick Zwarenstein ◽  
Mats Brommels ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Tertiary Care ◽  
Cost Benefit ◽  
Cost Effective ◽  
Additional Patient ◽  
Patient Volume ◽  
Benefit Ratio ◽  
Cost Benefit Ratio ◽  
The Cost

ABSTRACTObjectiveThe purpose of this study was to evaluate the cost-effectiveness of physician-nurse supplementary triage assistance team (MDRNSTAT) from a hospital and patient perspective.MethodsThis was a cost-effectiveness evaluation of a cluster randomized control trial comparing the MDRNSTAT with nurse-only triage in the emergency department (ED) between the hours of 0800 and 1500. Cost was MDRNSTAT salary. Revenue was from Ontario’s Pay-for-Results and patient volume-case mix payment programs. The incremental cost-effectiveness ratio was based on MDRNSTAT cost and three consequence assessments: 1) per additional patient-seen; 2) per physician initial assessment (PIA) hour saved; and 3) per ED length of stay (EDLOS) hour saved. Patient opportunity cost was determined. Patient satisfaction was quantified by a cost-benefit ratio. A sensitivity analysis extrapolating MDRNSTAT to different working hours, salary, and willingness-to-pay data was performed.ResultsThe added cost of the MDRNSTAT was $3,597.27 [$1,729.47 to ∞] per additional patient-seen, $75.37 [$67.99 to $105.30] per PIA hour saved, and $112.99 [$74.68 to $251.43] per EDLOS hour saved. From the hospital perspective, the cost-benefit ratio was 38.6 [19.0 to ∞] and net present value of –$447,996 [–$435,646 to –$459,900]. For patients, the cost-benefit ratio for satisfaction was 2.8 [2.3 to 4.6]. If MDRNSTAT performance were consistently implemented from noon to midnight, it would be more cost-effective.ConclusionsThe MDRNSTAT is not a cost-effective daytime strategy but appears to be more feasible during time periods with higher patient volume, such as late morning to evening.

scholarly journals Influenza A/H1N1 2009 Pandemic and Respiratory Virus Infections, Beijing, 2009–2010

PLoS ONE ◽  
2012 ◽  
Vol 7 (9) ◽  
pp. e45807 ◽  
Author(s):  
Yaowu Yang ◽  
Zhong Wang ◽  
Lili Ren ◽  
Wei Wang ◽  
Guy Vernet ◽  
...  
Keyword(s):  
Influenza A ◽  
Respiratory Virus ◽  
Virus Infections ◽  
Influenza A H1n1 ◽  
Respiratory Virus Infections

scholarly journals The cost-effectiveness of upfront point-of-care testing in the emergency department: a secondary analysis of a randomised, controlled trial

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Lara Nicole Goldstein ◽  
Mike Wells ◽  
Craig Vincent-Lambert
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Point Of Care ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Cost Effective ◽  
Economic Viability ◽  
Time Saving ◽  
Randomised Controlled ◽  
The Cost

Abstract Background Time-saving is constantly sought after in the Emergency Department (ED), and Point-of-Care (POC) testing has been shown to be an effective time-saving intervention. However, when direct costs are compared, these tests commonly appear to be cost-prohibitive. Economic viability may become apparent when the time-saving is translated into financial benefits from staffing, time- and cost-saving. The purpose of this study was to evaluate the cost-effectiveness of diagnostic investigations utilised prior to medical contact for ED patients with common medical complaints. Methods This was a secondary analysis of data from a prospective, randomised, controlled trial in order to assess the cost-effectiveness of upfront, POC testing. Eleven combinations of POC equivalents of commonly-used special investigations (blood tests (i-STAT and complete blood count (CBC)), electrocardiograms (ECGs) and x-rays (LODOX® (Low Dose X-ray)) were evaluated compared to the standard ED pathway with traditional diagnostic tests. The economic viability of each permutation was assessed using the Incremental Cost Effectiveness Ratio and Cost-Effectiveness Acceptability Curves. Expenses related to the POC test implementation were compared to the control group while taking staffing costs and time-saving into account. Results There were 897 medical patients randomised to receive various combinations of POC tests. The most cost-effective combination was the i-STAT+CBC permutation which, based on the time saving, would ultimately save money if implemented. All LODOX®-containing permutations were costlier but still saved time. Non-LODOX® permutations were virtually 100% cost-effective if an additional cost of US$50 per patient was considered acceptable. Higher staffing costs would make using POC testing even more economical. Conclusions In certain combinations, upfront, POC testing is more cost-effective than standard diagnostic testing for common ED undifferentiated medical presentations – the most economical POC test combination being the i-STAT + CBC. Upfront POC testing in the ED has the potential to not only save time but also to save money. Trial registration ClinicalTrials.gov: NCT03102216.

scholarly journals Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children

2019 ◽  
Vol 105 (3) ◽  
pp. 253-259 ◽  
Author(s):  
Jonathan Kaufman ◽  
Andrew Joshua Knight ◽  
Penelope A Bryant ◽  
Franz E Babl ◽  
Kim Dalziel
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Urine Sample ◽  
Cost Effective ◽  
Urine Collection ◽  
Collection Method ◽  
Non Invasive ◽  
Hospital Bed ◽  
The Cost ◽  
Collection Methods

BackgroundUrinary tract infection (UTI) is a common childhood infection. Many febrile children require a urine sample to diagnose or exclude UTI. Collecting urine from young children can be time-consuming, unsuccessful or contaminated. Cost-effectiveness of each collection method in the emergency department is unknown.ObjectiveTo determine the cost-effectiveness of urine collection methods for precontinent children.MethodsA cost-effectiveness analysis was conducted comparing non-invasive (urine bag, clean catch and 5 min voiding stimulation for clean catch) and invasive (catheterisation and suprapubic aspirate (SPA)) collection methods, for children aged 0–24 months in the emergency department. Costs included equipment, staff time and hospital bed occupancy. If initial collection attempts were unsuccessful subsequent collection using catheterisation was assumed. The final outcome was a definitive sample incorporating progressive dipstick, culture and contamination results. Average costs and outcomes were calculated for initial collection attempts and obtaining a definitive sample. One-way and probabilistic sensitivity analyses were performed.ResultsFor initial collection attempts, catheterisation had the lowest cost per successful collection (GBP£25.98) compared with SPA (£37.80), voiding stimulation (£41.32), clean catch (£52.84) and urine bag (£92.60). For definitive collection, catheterisation had the lowest cost per definitive sample (£49.39) compared with SPA (£51.84), voiding stimulation (£52.25), clean catch (£64.82) and urine bag (£112.28). Time occupying a hospital bed was the most significant determinant of cost.ConclusionCatheterisation is the most cost-effective urine collection method, and voiding stimulation is the most cost-effective non-invasive method. Urine bags are the most expensive method. Although clinical factors influence choice of method, considering cost-effectiveness for this common procedure has potential for significant aggregate savings.

A policy of day-case sinonasal surgery is safe, well tolerated and cost-effective

2021 ◽  
pp. 1-3
Author(s):  
M Duignan ◽  
C Lao ◽  
R Lawrenson ◽  
A J Wood
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Day Case ◽  
Day Case Surgery ◽  
Effectiveness Analysis ◽  
Same Day Discharge ◽  
Case Surgery ◽  
The Cost

Abstract Objective Practices vary regarding the timing of discharge after sinonasal surgery. This study aimed to examine the cost-effectiveness of same-day discharge compared to next-day discharge after sinonasal surgery. Methods A retrospective single-surgeon audit of sinonasal surgery over a 12-month period was performed. Demographic and clinical details, including distance travelled home, timing of discharge, hospital re-presentation, and complications, were collected and compared between the same-day discharge and next-day discharge groups. A cost-effectiveness analysis was performed. Results A total of 181 patients were identified; 117 underwent day-case surgery, of which 6 re-presented to the emergency department. Sixty-four patients stayed overnight after surgery, and six of those patients re-presented to the emergency department. The per patient cost was $3262 for day-case sinonasal surgery and $5050 for those admitted overnight after surgery (p < 0.001). Conclusion Routine same-day discharge after sinonasal surgery is achievable, safe and cost-effective.

scholarly journals 1182. Clinical Outcomes of Hospital-Associated Respiratory Virus Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S423-S424
Author(s):  
Joshua G Petrie ◽  
Adam S Lauring ◽  
Keith S Kaye
Keyword(s):  
Respiratory Syncytial Virus ◽  
Clinical Outcomes ◽  
Influenza A ◽  
Respiratory Virus ◽  
Diagnostic Testing ◽  
Direct Result ◽  
Molecular Diagnostic ◽  
Virus Infections ◽  
Syncytial Virus ◽  
Respiratory Virus Infections

Abstract Background Influenza and respiratory syncytial virus (RSV) are recognized as important causes of hospital-acquired infection. Increased use of multiplex molecular diagnostic testing is shedding light on the incidence of other hospital-associated respiratory virus infections (HA-RVI). However, the incidence and clinical impact of HA-RVI are not well understood. Methods We identified hospitalized patients admitted between July 1, 2017 and June 30, 2018 who were clinically tested to diagnose respiratory virus infections. HA-RVI were defined as respiratory virus positivity beginning more than 48 hours after hospital admission. The clinical outcomes of HA-RVI were compared with respiratory virus infections that were not considered hospital-associated (non-HA-RVI). Results Respiratory virus testing was performed on 4,690 individuals during 5,942 inpatient encounters. At least 1 virus was identified in 1,871 (31%) encounters, and 229 (12%) were defined as HA-RVI (median hours from admission to positivity [IQR]: 154 [79, 308]). Among the patients with a respiratory virus infection, 56% were adults, 52% were male, 77% were non-Hispanic white, and the median Charlson score was 2 (IQR: 1, (4); HA-RVI patients were more likely to be male (59% vs. 51%, P = 0.01) and had higher median Charlson scores (3 vs. 2, P < 0.001). All 14 respiratory viruses in the diagnostic panel were positive for at least one HA-RVI (Figure 1), but rhino/enterovirus (99), influenza A (27), human metapneumovirus (22) and respiratory syncytial virus (20) were most common. Compared with non-HA-RVI patients, those with HA-RVI had longer post-infection lengths of stay (median: 9 vs. 4 days, P < 0.001) and were more likely to die during hospitalization (odds ratio [95% confidence interval]: 3.4 [2.0, 5.7]) (Table 1). Conclusion A substantial number of HA-RVI were identified during the 2017–2018 respiratory virus season, and they were associated with a striking number of severe outcomes. More in depth analyses are required to determine whether severe outcomes are a direct result of HA-RVI or whether HA-RVI are more common in critically ill patients and serve as a marker for severe morbidity. A broader understanding of HA-RVI transmission and prevention strategies is needed. Disclosures All authors: No reported disclosures.

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