title: Cost effectiveness of pneumococcal urinary antigen in Emergency Department: a pragmatic real-life study.
abstract: Community-acquired pneumonia (CAP) is frequent and can be life-threatening. Streptococcus pneumoniae is the main bacteria involved, and is susceptible to penicillin A. Rapid microbiological diagnosis could then help reduce the antimicrobial spectrum. The pneumococcal urinary antigen (PUA) test is fast and easy to perform, but its impact on antimicrobial prescription and cost-effectiveness in emergency departments (ED) is not well known. We performed a pragmatic real life retrospective study in an adult ED to assess its usefulness: proportion of positive results, impact on antimicrobial prescriptions and cost-effectiveness. Over 3 years (from January 1st 2012 to December 31st 2014), 979 PUA tests were reutilized in our ED among 1224 patients who consulted for CAP; 51 (5.2%) were positive. Among them, 10 led to a modification of the antimicrobial treatment, but only 7 (14.3%) were in accordance with the results. The total cost of a PUA test is 27€. As only 7 PUA tests led to appropriate antimicrobial modification, we deemed that 972 had no impact, and the potential cost savings, if the test had not been used, would have been 26,244 € (972 × 27) during 3 years, that is 8748 € per year. Thus, it seems that the PUA test should not be generally used in the ED considering its low rate of positivity and the difficulties for physicians to adapt antibiotic treatment accordingly. This attitude change in utilization would lead to substantial cost savings.
authors.affiliation: Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France. aurelien.dinh@aphp.fr.
authors.forename: Aurélien
authors.identifier: 0000-0002-5843-4819
authors.initials: A
authors.lastname: Dinh
authors.affiliation: Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
authors.forename: Clara
authors.initials: C
authors.lastname: Duran
authors.affiliation: Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Davido
authors.affiliation: Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Lagrange
authors.affiliation: Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Sivadon-Tardy
authors.affiliation: Pharmacy Department, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, Garches, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Bouchand
authors.affiliation: IT Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Beauchet
authors.affiliation: Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gaillard
authors.affiliation: Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Beaune
authors.affiliation: Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Salomon
authors.affiliation: Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Grenet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000032:analysis* / Q000191:economics / Q000378:metabolism; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques / Q000191:economics / Q000379:methods; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000276:immunology / Q000652:urine*; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000378:metabolism* / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial
keywords: Bacterial; Clinical management; Community-acquired pneumonia; Cost effectiveness; Infectious diseases