Cost impact analysis of novel host-response diagnostic for patients with community-acquired pneumonia in the emergency department

Abstract

Background

There is significant over-prescription of antibiotics for suspected community-acquired pneumonia (CAP) patients as bacterial and viral pathogens are difficult to differentiate. To address this issue, a host response diagnostic called MeMed BV (MMBV) was developed that accurately differentiates bacterial from viral infection at the point of need by integrating measurements of multiple biomarkers. A literature-based cost-impact model was developed that compared the cost impact and clinical benefits between using the standard of care diagnostics combined with MMBV relative to standard of care diagnostics alone.

Methods

The patient population was stratified according to the pneumonia severity index, and cost savings were considered from payer and provider perspectives. Four scenarios were considered. The main analysis considers the cost impact of differences in antibiotic stewardship and resulting adverse events. The first, second, and third scenarios combine the impacts on antibiotic stewardship with changes in hospital admission probability, length of hospital stay and diagnosis related group (DRG) reallocation, and hospital admission probability, length of stay, and DRG reallocation in combination, respectively.

Results

The main analysis results show overall per-patient savings of $37 for payers and $223 for providers. Scenarios 1, 2, and 3 produced savings of $137, $189, and $293 for payers, and $339, $713, and $809 for providers, respectively.

Limitations

Models are simulations of real-world clinical processes, and are not sensitive to variations in clinical practice driven by differences in physician practice styles, differences in facility-level practice patterns, and patient comorbidities expected to exacerbate the clinical impact of CAP. Hospital models are limited to costs and do not consider differences in revenue associated with each approach.

Conclusions

Introducing MMBV to the current SOC diagnostic process is likely to be cost-saving to both hospitals and payers when considering impacts on antibiotic distribution, hospital admission rate, hospital LOS, and DRG reallocation.

Keywords:

• Community-acquired pneumonia
• lower respiratory tract infection
• host response
• infection
• cost-impact
• economics
• diagnostics

JEL Classification Codes:

• I10
• I1
• I
• I15

Transparency

Declaration of funding

This study was funded by MeMed Ltd.

Declaration of financial/other interests

JES is CEO and Principal of Avalon Health Economics, and JTC is an employee of Avalon Health Economics. Avalon Health Economics was contracted for the completion of this work by MeMed Ltd.

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

Author contributions

JES designed the analysis, oversaw model development, and contributed to the writing of the manuscript. JTC performed the analysis and drafted the manuscript. Both authors reviewed and approved the final report.

Acknowledgements

None stated.

Notes

i The 50% increase in antibiotic treatment length is an assumption based on evidence regarding increased length of hospital stay for FN patients, described in detail in the Scenario Analysis 2: Length of Stay Impact and DRG Reallocation section. It was assumed that the magnitude of impact on hospital LOS would be representative of the impact on antibiotic treatment length.