[Medical and economic aspects of early microbiological diagnosis in patients with severe infections].
OBJECTIVE
The decision tree analysis is based on a study of v. Doern comparing the medical costs of a diagnosis by means of a traditional method (ONAST) to a new and quicker method (RAST). The conclusion is that, the traditional method proofs to be more expensive regarding different types of costs. A goal of this analysis was to prove the results of this US study for an application in the German health care system.


METHODS
A cost efficacy analysis by means of a decision tree was carried out measuring the costs using the surviving of patients as a parameter. As in the RAST group 24 out of 273 and in the ONAST group 46 in 300 persons died, the efficacy rates amount to 0.912 and 0.847, respectively. Finally, sensitivity analyses were performed.


RESULTS
Results of total (direct and indirect) costs per surviving patient showed an advantage of the RAST procedure amounting to DM 3,653 (28.3%) compared to the ONAST procedure. From the perspective of a German sickness fund, the RAST procedure leads to a saving potential of about DM 2,671 (13.0%) in comparison to the ONAST procedure. As a result, a minimum of 10 patients a year are required to save costs from the perspective of the hospital. If costs for drugs in the RAST procedure amount to DM 8,764.93, equality of total costs is obtained. This case is rather unlikely.


CONCLUSIONS
From both perspectives of the payer as well as that of the hospital it can be concluded that the rapid method is more cost-effective than the overnight method.
Siedentop
H
H
Institut für Empirische Gesundheitsökonomie, Burscheid. instfeg@t-online.de
Rychlik
R
R
D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016527:Drug Costs / Q000706:statistics & numerical data; D005858:Germany; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000175:diagnosis* / Q000191:economics* / Q000401:mortality; D007902:Length of Stay; D008828:Microbiological Techniques / Q000191:economics* / Q000295:instrumentation*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013997:Time Factors; D014481:United States
Medizinische und ökonomische Aspekte einer frühzeitigen mikrobiologischen Diagnose bei Patienten mit schweren Infektionen.