Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
J Antimicrob Chemother. 2022 Feb 2;77(2):507-516. doi: 10.1093/jac/dkab398.
Gram-negative pathogens, such as Escherichia coli, are common causes of bloodstream infections (BSIs) and increasingly demonstrate antimicrobial resistance. Molecular rapid diagnostic tests (mRDTs) offer faster pathogen identification and susceptibility results, but higher costs compared with conventional methods. We determined the cost-effectiveness of the BioFire FilmArray Blood Culture Identification (BCID) Panel, as a type of mRDT, compared with conventional methods in the identification of E. coli BSIs.
We constructed a decision analytic model comparing BCID with conventional methods in the identification and susceptibility testing of hospitalized patients with E. coli BSIs from the perspective of the public healthcare payer. Model inputs were obtained from published literature. Cost-effectiveness was calculated by determining the per-patient admission cost, the QALYs garnered and the incremental cost-effectiveness ratios (ICERs) where applicable. Monte Carlo probabilistic sensitivity analyses and one-way sensitivity analyses were conducted to assess the robustness of the model. All costs reflect 2019 Canadian dollars.
The Monte Carlo probabilistic analyses resulted in cost savings ($27 070.83 versus $35 649.81) and improved QALYs (8.65 versus 7.10) in favour of BCID. At a willingness to pay up to $100 000, BCID had a 72.6%-83.8% chance of being cost-effective. One-way sensitivity analyses revealed length of stay and cost per day of hospitalization to have the most substantial impact on costs and QALYs.
BCID was found to be cost-saving when used to diagnose E. coli BSI compared with conventional testing. Cost savings were most influenced by length of stay and cost per day of hospitalization.
革兰氏阴性病原体，如大肠杆菌，是血流感染（BSI）的常见原因，并表现出越来越多的抗药性。分子快速诊断测试（mRDT）提供了更快的病原体鉴定和药敏结果，但与传统方法相比成本更高。我们确定了生物火膜阵列血培养鉴定（BCID）面板作为一种 mRDT，与传统方法相比，在鉴定大肠杆菌 BSI 方面的成本效益。
我们构建了一个决策分析模型，从公共医疗保健支付者的角度比较了 BCID 与传统方法在鉴定和药敏试验中的差异，比较了住院患者大肠杆菌 BSI 的检测。模型输入来自已发表的文献。通过确定每位患者的入院费用、获得的 QALYs 和增量成本效益比（ICER）来计算成本效益，在适用的情况下。进行了蒙特卡罗概率敏感性分析和单向敏感性分析，以评估模型的稳健性。所有成本均反映 2019 年加拿大元。
蒙特卡罗概率分析结果表明，BCID 具有成本效益（节省 27070.83 加元，35649.81 加元）和改善的 QALYs（8.65 个质量调整生命年，7.10 个质量调整生命年）。在愿意支付高达 100000 加元的情况下，BCID 有 72.6%-83.8%的可能性具有成本效益。单向敏感性分析显示，住院时间和住院日成本对成本和 QALYs 的影响最大。
与传统检测相比，BCID 用于诊断大肠杆菌 BSI 时具有成本效益。节省成本主要受住院时间和住院日成本的影响。
