title: Cost-effectiveness analysis of early point-of-care lactate testing in the emergency department.
abstract: To determine the cost-effectiveness of implementing a point-of-care (POC) Lactate Program in the emergency department (ED) for patients with suspected sepsis to identify patients who can benefit from early resuscitation.
  
  
  
  We constructed a cost-effectiveness model to examine an ED with 30 000 patients annually. We evaluated a POC lactate program screening patients with suspected sepsis for an elevated lactate ≥4 mmol/L. Those with elevated lactate levels are resuscitated and their lactate clearance is evaluated by serial POC lactate measurements. The POC Lactate Program was compared with a Usual Care Strategy in which all patients with sepsis and an elevated lactate are admitted to the intensive care unit. Costs were estimated from the 2014 Medicare Inpatient and National Physician Fee schedules, and hospital and industry estimates.
  
  
  
  In the base-case, the POC Lactate Program cost $39.53/patient whereas the Usual Care Strategy cost $33.20/patient. The screened patients in the POC arm resulted in 1.07 quality-adjusted life years for an incremental cost-effectiveness ratio of $31 590 per quality-adjusted life year gained, well below accepted willingness-to-pay-thresholds.
  
  
  
  Implementing a POC Lactate Program for screening ED patients with suspected sepsis is a cost-effective intervention to identify patients responsive to early resuscitation.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, 1313 21(st) Ave South, Nashville, TN 37232. Electronic address: michael.j.ward@vanderbilt.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ward
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.affiliation: Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, NY.
authors.forename: Adam
authors.initials: A
authors.lastname: Singer
authors.affiliation: Office for Clinical Practice Innovation, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Danielle
authors.initials: D
authors.lastname: Lazar
authors.affiliation: Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Health Policy, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D000067716:Point-of-Care Testing / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012151:Resuscitation; D018805:Sepsis / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy
chemical_list: D019344:Lactic Acid
keywords: Economic analysis; Emergency department; Resuscitation; Sepsis