Oostenbrink JB, Redekop WK, Oostenbrink R, Moons KG, Moll HA, Grobbee DE; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2000; 16: 286.
Introduction: In developing a new diagnostic strategy it is important not only to assess the strategy in terms of effectiveness, but also in terms of efficiency. Even when the new strategy does not lead to a higher number of correctly diagnosed patients, the efficiency of the new diagnostic strategy can be assessed by determining the cost-savings of diagnostic tests and immediate treatment. The aim of this study was to determine an efficient strategy for diagnosing bacterial meningitis in patients with neck-stiffness. Methods: A retrospective study was performed using data of 360 patients with neck stiffness visiting the emergency department of the Sophia Children's Hospital in Rotterdam, the Netherlands, between 1988 and 1998. Logistic regression was used to determine an optimal diagnostic strategy. To calculate potential cost savings the cost of the current strategy and treatment were compared with the expected costs if the new strategy would have been applied. Results were verified using prospective validation. Results: In addition to patient history and patient examination, only one laboratory test was found to be of value. A problem in determining the potential cost-savings was the absence of a diagnostic protocol in the current situation. A second problem concerned the uncertainty about why tests were performed in the past (e.g. determining the differential diagnosis), which may vary from patient to patient. To make a realistic estimate of the cost-savings of the new strategy, patients were divided into three groups according to their main diagnosis. Only the expected cost-savings in patients with non-serious infections were taken into account. Discussion: To determine the cost-savings of a new diagnostic strategy it is necessary to have insight into current diagnostic practice. The use of prospective validation is one of the solutions to verify the feasibility of the new protocol and the accuracy of the calculated cost-savings.
Publication Types:
Keywords:
- Child
- Cost Savings
- Costs and Cost Analysis
- Diagnosis, Differential
- Humans
- Longitudinal Studies
- Meningitis, Bacterial
- Netherlands
- Physical Examination
- Retrospective Studies
- diagnosis
- economics
- therapy
- ultrasonography
- hsrmtgs
Other ID:
UI: 102271938
From Meeting Abstracts