title: Effectiveness and cost of quick diagnostic tests to determine tetanus immunity in patients with a wound in French emergency departments.
abstract: BACKGROUND
  Tétanos Quick Stick® (TQS) is a test for tetanus immunity screening for wounded patients in emergency departments (EDs), but represents additional costs compared with a medical interview on vaccination history. The study objective was to assess the effectiveness and cost of the TQS in French EDs.
  
  
  METHODS
  We performed a model-based analysis that simulates screening of tetanus immunity and risk of tetanus based on prophylaxis administration. Strategies compared were: i) diagnosis of tetanus immunity by "TQS"; ii) "Medical Interview" (current practice). The study population was 1,658,000 French adults seeking ED care for a wound in 2012. Model parameters were estimated based on French national surveillance data, and published literature. Outcome measures were number of tetanus cases, life years gained and costs (2012 €) from a societal perspective.
  
  
  RESULTS
  Use of TQS had negligible impact on health outcomes (0.02 tetanus cases/year in France vs. 0.41 for "Medical Interview"), but resulted in a decrease in annual costs of €2,203,000 (-42%). Base case and sub-group analysis showed that with the same effectiveness, the average cost per patient was: €13 with "Medical Interview" vs. €11.7 with TQS for the overall cohort; €28.9 with "Medical Interview" vs. €21 with "TQS" for tetanus-prone wounds; €15 with "Medical Interview" vs. €14.1 with "TQS" for patients aged ≥65 years; and €6.2 with "Medical Interview" vs. €7.8 with "TQS" for non-tetanus-prone wounds.
  
  
  CONCLUSIONS
  Use of TQS is as effective and less costly than "Medical Interview" when applied in ED to wounded patients with tetanus-prone wounds or aged ≥65 years. However, it is more expensive in patients with non-tetanus-prone wounds.
authors.forename: Dieynaba S
authors.initials: DS
authors.lastname: N'Diaye
authors.forename: Michaël
authors.initials: M
authors.lastname: Schwarzinger
authors.forename: Dorothée
authors.initials: D
authors.lastname: Obach
authors.forename: Julien
authors.initials: J
authors.lastname: Poissy
authors.forename: Sophie
authors.initials: S
authors.lastname: Matheron
authors.forename: Enrique
authors.initials: E
authors.lastname: Casalino
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000276:immunology*; D003017:Clostridium tetani / Q000276:immunology*; D003198:Computer Simulation; D004636:Emergency Service, Hospital; D005602:France; D006801:Humans; D008875:Middle Aged; D013742:Tetanus / Q000276:immunology / Q000517:prevention & control*; D013745:Tetanus Toxoid / Q000191:economics / Q000276:immunology / Q000627:therapeutic use*; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D013745:Tetanus Toxoid