Economic consequence of immediate testing for C-reactive protein and leukocyte count in new outpatients with acute infection.
BACKGROUND
There have been few well-designed studies that assess the cost-effectiveness of near-patient immediate testing.


METHODS
We analyzed the economic outcome of immediate testing for C-reactive protein (CRP) and white blood cell count (WBC) in 305 new outpatients with acute infections. Patients were randomized into two groups: 147 patients were tested immediately for CRP and WBC before the physician's initial consultation (advance testing), and 154 patients were not subjected to advance testing. The subsequent prescribing decision and the drug/testing/personnel costs were compared between the groups.


RESULTS
In the advance-testing group, the initial consultation was followed by a total of 84 prescriptions of oral antibiotics, against 158 in the other group. Comparing the total costs of oral and parenteral antibiotics between the two groups, a 30% reduction was achieved with advance testing ( yen105,830 vs. yen151,102). However, the savings were largely offset by frequent prescription of newer, expensive influenza neuraminidase inhibitors. Advance testing also significantly reduced additional laboratory use. More frequent urgent testing increased personnel costs in the non-advance-testing group. Overall, total cost was somewhat higher in the advance-testing group ( yen1,028,827 vs. yen984,105).


CONCLUSIONS
The cost per antibiotic prescription reduced with advance testing was yen604 (approximately 5.8 US dollars) in our clinical setting. Judicious use of antivirals and introduction of a simple CRP test kit would improve cost-effectiveness.
Takemura
Yuzuru
Y
Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. yutakemu@interlink.or.jp
Ishida
Haku
H
Saitoh
Hiroki
H
Kure
Hideki
H
Kakoi
Hideo
H
Ebisawa
Ken
K
Kure
Morimitsu
M
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000191:economics; D002097:C-Reactive Protein / Q000032:analysis*; D003362:Cost-Benefit Analysis; D019937:Diagnostic Techniques and Procedures / Q000191:economics*; D011307:Drug Prescriptions / Q000191:economics; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D007564:Japan; D007958:Leukocyte Count / Q000191:economics*; D010045:Outpatients
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein