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Journal of Clinical Microbiology, October 2003, p. 4708-4713, Vol. 41, No. 10
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.10.4708-4713.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Algorithm To Determine Cost Savings of Targeting Antimicrobial Therapy Based on Results of Rapid Diagnostic Testing

J. J. Oosterheert,^1* M. J. M. Bonten,^1,2 E. Buskens,³ M. M. E. Schneider,¹ and I. M. Hoepelman^1,2

Department of Emergency Medicine and Infectious Diseases,¹ Julius Centre for Health Sciences and Primary Care,³ Eijkman Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Centre Utrecht, Utrecht, The Netherlands²

Received 15 May 2003/ Returned for modification 14 July 2003/ Accepted 22 July 2003

A rapid diagnosis of pneumococcal pneumonia may allow the earlier use of narrow-spectrum antimicrobial therapy. It is unknown, however, whether rapid diagnostic testing of patients hospitalized with community-acquired pneumonia (CAP) admitted to hospital lowers costs. Therefore, an algorithm to calculate the costs associated with the diagnosis and treatment of CAP was formulated. Subsequently, the algorithm was applied to clinical data for 122 consecutively admitted patients with CAP whose sputum samples were Gram stained and whose urine was tested for Streptococcus pneumoniae antigen. The costs of initial antimicrobial therapy, personnel, and materials were measured. Compared to the most expensive empirical regimen, rapid diagnostic testing would result in cost savings per patient (PP) of 3.51 for Gram staining and 8.11 for urinary pneumococcal antigen testing (1 is equal to US$1.13, from 2000 to 2002). Compared to the cheapest regimen, Gram staining would increase the cost by 2.25 PP, and urinary antigen testing would increase the cost by 24.26 PP. In our setting, the use of rapid diagnostic testing would not lower costs. Cost savings depend, however, on the differences in the prices of the different antibiotics chosen and the proportion of evaluable and positive samples.

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* Corresponding author. Mailing address: Department of Emergency Medicine and Infectious Diseases, University Medical Centre Utrecht, Room F02.126, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Phone: 31 30 2509429. Fax: 31 30 2523741. E-mail: J.J.Oosterheert{at}azu.nl.

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Journal of Clinical Microbiology, October 2003, p. 4708-4713, Vol. 41, No. 10
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.10.4708-4713.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

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