title: Clinical and Cost-Effectiveness of Procalcitonin Test for Prodromal Meningococcal Disease-A Meta-Analysis.
abstract: BACKGROUND
  Despite vaccines and improved medical intensive care, clinicians must continue to be vigilant of possible Meningococcal Disease in children. The objective was to establish if the procalcitonin test was a cost-effective adjunct for prodromal Meningococcal Disease in children presenting at emergency department with fever without source.
  
  
  RESULTS
  Data to evaluate procalcitonin, C-reactive protein and white cell count tests as indicators of Meningococcal Disease were collected from six independent studies identified through a systematic literature search, applying PRISMA guidelines. The data included 881 children with fever without source in developed countries.The optimal cut-off value for the procalcitonin, C-reactive protein and white cell count tests, each as an indicator of Meningococcal Disease, was determined. Summary Receiver Operator Curve analysis determined the overall diagnostic performance of each test with 95% confidence intervals. A decision analytic model was designed to reflect realistic clinical pathways for a child presenting with fever without source by comparing two diagnostic strategies: standard testing using combined C-reactive protein and white cell count tests compared to standard testing plus procalcitonin test. The costs of each of the four diagnosis groups (true positive, false negative, true negative and false positive) were assessed from a National Health Service payer perspective. The procalcitonin test was more accurate (sensitivity=0.89, 95%CI=0.76-0.96; specificity=0.74, 95%CI=0.4-0.92) for early Meningococcal Disease compared to standard testing alone (sensitivity=0.47, 95%CI=0.32-0.62; specificity=0.8, 95% CI=0.64-0.9). Decision analytic model outcomes indicated that the incremental cost effectiveness ratio for the base case was £-8,137.25 (US $ -13,371.94) per correctly treated patient.
  
  
  CONCLUSIONS
  Procalcitonin plus standard recommended tests, improved the discriminatory ability for fatal Meningococcal Disease and was more cost-effective; it was also a superior biomarker in infants. Further research is recommended for point-of-care procalcitonin testing and Markov modelling to incorporate cost per QALY with a life-time model.
authors.affiliation: Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bell
authors.affiliation: Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Shields
authors.affiliation: Northern Ireland Clinical Trial Unit, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
authors.forename: Ashley
authors.initials: A
authors.lastname: Agus
authors.affiliation: Ulster Hospital Dundonald, South Eastern Health and Social Care Trust Belfast, Northern Ireland, United Kingdom.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dunlop
authors.affiliation: Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bourke
authors.affiliation: UKCRC Centre of Excellence for Public Health (NI), School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.affiliation: School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lynn
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood* / Q000191:economics*; D015740:Calcitonin Gene-Related Peptide; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D003663:Decision Trees; D006801:Humans; D007958:Leukocyte Count; D008589:Meningococcal Infections / Q000097:blood* / Q000175:diagnosis*; D011498:Protein Precursors / Q000097:blood* / Q000191:economics*; D012372:ROC Curve
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide