Modeling the economic impact of different testing strategies for meningitis/encephalitis in adult patients from a US hospital perspective.

INTRODUCTION

Meningitis and encephalitis (ME) are life-threatening conditions whose severity vary by etiology. Often, patients with suspected ME are unnecessarily hospitalized and treated with empiric therapy while clinicians determine etiology. ME diagnosis and treatment algorithms vary across hospitals, with some using a battery of rapid diagnostic tests (RDTs) or multiplex/syndromic testing, and others relying only on bacterial culture and send-out tests.

AIM: We modeled the economic impact of 4 ME testing strategies from a US hospital perspective.

METHODS

A synthetic sample of 20,000 suspected ME cases was generated based on published ME etiology distribution. A Monte Carlo model simulated diagnosis, treatment, and resource use/costs from a US community hospital perspective in 4 scenarios: syndromic testing, syndromic testing in conjunction with RDTs, a battery of 4 RDTs, and off-site-only testing. Mean inpatient resource use and cost per suspected ME case were estimated. Sensitivity analyses were conducted.

RESULTS

Mean (95% confidence interval [CI]) cost per suspected ME case was $15,465 ($15,285-$15,644) with syndromic testing, $15,720 ($15,536-$15,903) under conjunction testing, $16,412 ($16,226-$16,598) with the battery of 4 RDTs, and $19,337 ($19,150-$19,525) with off-site-only testing. Cost savings were driven by reductions in hospital stay from reduced time to correct pathogen identification. Test performance characteristics and time to pathogen identification had the largest impact on modeled costs.

CONCLUSION

Using the battery of 4 RDTs or syndromic testing would result in cost savings for hospitals currently not using RDTs. Syndromic testing would yield additional savings over the battery of 4 RDTs by further shortening hospital stays.

SUMMARY: A simulation model estimated that syndromic testing would result in cost savings of $947-$3,873 compared with rapid diagnostic testing and off-site-only testing from a US hospital perspective, through reductions in length of stay, due to more timely pathogen diagnosis.