Bognar Katalin, Shafrin Jason, Brauer Michelle, Zhao Lauren, Hockett Rick, O'Neil Michael, Jena Anupam
a Precision Health Economics , Los Angeles , CA , USA.
b Genalyte , San Diego , CA , USA.
J Med Econ. 2018 Nov;21(11):1057-1066. doi: 10.1080/13696998.2018.1502191. Epub 2018 Aug 16.
Improvements in information technology have granted the recent development of rapid, cloud-enabled, onsite laboratory testing for rheumatoid arthritis (RA). This study aims to quantify the value to payers of such technologies.
To calculate the value of rapid, cloud-enabled, onsite laboratory testing to diagnose RA relative to traditional, centralized laboratory testing, an Excel-based decision tree model was created that simulated potential cost-savings to payers who cover routine evaluations of RA patients in the US. First, a conceptual framework was created to identify the value components of rapid, cloud-enabled onsite testing. Second, value associated with patient time savings, savings on visit fees, change in treatment costs, and QALY improvements was measured, leveraging existing literature and information from an observational study. Lastly, these value components were combined to estimate the total incremental value accruing to payers per patient-year relative to centralized laboratory testing.
Rapid, cloud-enabled, onsite testing is estimated to save one office and 1.81 laboratory visits during the evaluation period for the average patient. Results from an observational study found that rapid, cloud-enabled testing increased the likelihood of completing diagnostic orders from 84.5% to 97%, resulting in an increased probability of early treatment (3.5 percentage points) with disease-modifying anti-rheumatic drugs among patients eligible for treatment. The combined total value was $5,648 per evaluated patient-year. This value is primarily attributed to health benefits of early treatment ($5,048), fewer visit payments ($459), and patient time savings due to fewer office ($216) and laboratory visits ($255).
Data on the impact of rapid, cloud-enabled, onsite testing on patient health, care delivery, and clinical decision-making is scarce. More robust real-world data would confirm the validity of our model. Rapid, cloud-enabled, onsite testing has the potential to generate significant value to payers.
信息技术的进步推动了类风湿关节炎（RA）快速、基于云的现场实验室检测的近期发展。本研究旨在量化此类技术对支付方的价值。
为了计算相对于传统集中式实验室检测而言，快速、基于云的现场实验室检测在诊断RA方面对支付方的价值，创建了一个基于Excel的决策树模型，该模型模拟了为美国RA患者进行常规评估的支付方可能节省的成本。首先，创建一个概念框架以确定快速、基于云的现场检测的价值组成部分。其次，利用现有文献和一项观察性研究的信息，衡量与节省患者时间、节省就诊费用、治疗成本变化以及质量调整生命年（QALY）改善相关的价值。最后，将这些价值组成部分相结合，以估计相对于集中式实验室检测，每位患者每年支付方获得的总增量价值。
据估计，对于普通患者，在评估期间快速、基于云的现场检测可节省一次门诊就诊和1.81次实验室检测就诊。一项观察性研究的结果发现，快速、基于云的检测将完成诊断医嘱的可能性从84.5%提高到97%，从而使符合治疗条件的患者使用改善病情抗风湿药物进行早期治疗的概率提高了3.5个百分点。每位评估患者每年的总价值为5648美元。这一价值主要归因于早期治疗的健康益处（5048美元）、较少的就诊费用（459美元）以及由于门诊就诊（216美元）和实验室检测就诊次数减少（255美元）而节省的患者时间。
关于快速、基于云的现场检测对患者健康、医疗服务提供和临床决策影响的数据稀缺。更有力的真实世界数据将证实我们模型的有效性。快速、基于云的现场检测有可能为支付方创造巨大价值。
