Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.
Department of Microbiology, School of Medicine, University of Valenciagrid.5338.d, Valencia, Spain.
Microbiol Spectr. 2022 Oct 26;10(5):e0088022. doi: 10.1128/spectrum.00880-22. Epub 2022 Sep 7.
Economic assessment is required to gauge the value of implementing PCR syndromic platforms in the microbiology laboratory for the diagnosis of community-acquired acute gastroenteritis (AGE) in pediatric and adult in- and outpatients. A cost-benefit analysis was conducted from a health care system perspective using BD MAX Enteric Bacterial, Bacterial Plus, and Virus panels. Two 6-month periods were selected, in which either conventional procedures (in 2017) or BD MAX PCR multiplex panels (in 2018) were used. We retrospectively reviewed medical records of all patients with positive results and a representative sample of negative ones. A Markov model was used to represent transition probabilities between different health care states from time of stool microbiological study until completion of AGE-episode-associated health care. A total of 1,336 medical records were reviewed (829 in 2018 and 507 in 2017), showing overall a significantly higher positivity rate in 2018 than in 2017 (26% versus 6%, 0.001). The total cost per individual associated with health care for AGE was €314 in 2018 and €341 in 2017; when we only considered the pediatric cohort, the figures were €271 and €456, respectively. Using Tornado sensitivity analyses, we found that the three variables that most influenced the model in descending order of weight were the probability of longer hospital stays, the probability of returning to the emergency room (ER), and the probability of hospitalization from the ER. Use of BD MAX enteric PCR platforms for the diagnosis of community-acquired AGE instead of a non-PCR-based conventional approach results in an incremental benefit from a health care perspective in the general population, particularly children. The implementation of multiplex molecular panels allows microbiological laboratories to quickly, sensitively, and accurately diagnose acute infectious gastroenteritis. This methodology therefore allows faster decisions regarding treatment and infection control measures. Economic evaluations are required to gauge the value of implementing these syndromic PCR platforms in a community-based acute gastroenteritis setting. We studied the potential clinical and cost benefits, in terms of both their impact on laboratory costs and the subsequent costs of managing patients.
需要进行经济评估，以衡量在儿科和成人门诊和住院患者中，为诊断社区获得性急性肠胃炎（AGE）而在微生物实验室中实施聚合酶链反应（PCR）综合平台的价值。从医疗保健系统的角度出发，采用 BD MAX 肠道细菌、细菌加病毒检测板进行了成本效益分析。选择了两个 6 个月的时间段，在其中一个时间段（2017 年）采用传统方法，在另一个时间段（2018 年）采用 BD MAX PCR 多重检测板。我们回顾性地审查了所有阳性患者的病历和有代表性的阴性患者病历。采用 Markov 模型代表从粪便微生物研究开始到完成与 AGE 相关的医疗保健的不同医疗保健状态之间的转移概率。共审查了 1336 份病历（2018 年 829 份，2017 年 507 份），显示 2018 年的总体阳性率明显高于 2017 年（26%对 6%，0.001）。2018 年和 2017 年与 AGE 相关的医疗保健的个体总成本分别为 314 欧元和 341 欧元；当仅考虑儿科队列时，这两个数字分别为 271 欧元和 456 欧元。通过龙卷风敏感性分析，我们发现，从权重降序排列，影响模型的三个变量依次为住院时间延长的概率、急诊室（ER）复诊的概率和从 ER 住院的概率。使用 BD MAX 肠道 PCR 平台而非非 PCR 基于传统方法诊断社区获得性 AGE，从一般人群的医疗保健角度来看，会产生额外的收益，尤其是儿童。采用多重分子检测板可以使微生物实验室快速、敏感、准确地诊断急性感染性肠胃炎。因此，这种方法可以更快地决定治疗和感染控制措施。需要进行经济评估，以衡量在社区为基础的急性肠胃炎环境中实施这些综合 PCR 平台的价值。我们研究了潜在的临床和成本效益，从对实验室成本的影响以及随后管理患者的成本方面进行了评估。
