PloS one · 2020
Evaluating the cost-consequence of a standardized strategy for the etiological diagnosis of uveitis (ULISSE study).
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАEquivalence TrialНазвание и аннотация: Перевод в очереди
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de Parisot Audrey, Jamilloux Yvan, Kodjikian Laurent, Errera Marie-Hélène, Sedira Neila, Heron Emmanuel, Pérard Laurent, Cornut Pierre-Loïc, Schneider Christelle, Rivière Sophie, Ollé Priscille, Pugnet Grégory, Cathébras Pascal, Manoli Pierre, Bodaghi Bahram, Saadoun David, Baillif Stéphanie, Tieulie Nathalie, André Marc, Chiambaretta Frédéric, Bonin Nicolas, Bielefeld Philip, Bron Alain, Mouriaux Frédéric, Bienvenu Boris, Amamra Nassira, Guerre Pascale, Decullier Evelyne, Sève Pascal, ULISSE group
Аннотация
MAIN OBJECTIVE: To prospectively assess the cost-consequence of a standardized diagnostic strategy as to compared to an open one for the etiological diagnosis of uveitis.
DESIGN: This was a prospective, non-inferiority, multicentre, randomized controlled trial.
METHODS: We included all consecutive patients with uveitis who had visited at least one of the Departments of Ophthalmology. In the standardized group, patients had a minimal work-up regardless of the type of uveitis (including evaluation of the CBC, ESR, C-reactive protein, tuberculin skin test, syphilis serology and chest X-ray). Depending on ophthalmological findings, further investigations could be performed. In the open strategy, ophthalmologists were free to order any kind of investigation. The main outcome was the mean cost per patient of each strategy.
RESULTS: 903 uveitis patients were included from January, 2010 to May, 2013. The mean cost per patient of the standardized strategy was 182.97 euros [CI 95% (173.14; 192.80)], and the mean cost per patient of the open strategy was 251.75 euros [CI 95% (229.24; 274.25)]. Therefore, the mean cost per patient of the standardized strategy was significantly lower than the mean cost per patient of the open strategy (p<0.001). There were significantly fewer visits (p<0.001), fewer radiological procedures (p<0.004) and fewer laboratory investigations (p<0.001) in the standardized group.
CONCLUSION: A standardized strategy is a cost-saving approach for the etiological diagnosis of uveitis.
DESIGN: This was a prospective, non-inferiority, multicentre, randomized controlled trial.
METHODS: We included all consecutive patients with uveitis who had visited at least one of the Departments of Ophthalmology. In the standardized group, patients had a minimal work-up regardless of the type of uveitis (including evaluation of the CBC, ESR, C-reactive protein, tuberculin skin test, syphilis serology and chest X-ray). Depending on ophthalmological findings, further investigations could be performed. In the open strategy, ophthalmologists were free to order any kind of investigation. The main outcome was the mean cost per patient of each strategy.
RESULTS: 903 uveitis patients were included from January, 2010 to May, 2013. The mean cost per patient of the standardized strategy was 182.97 euros [CI 95% (173.14; 192.80)], and the mean cost per patient of the open strategy was 251.75 euros [CI 95% (229.24; 274.25)]. Therefore, the mean cost per patient of the standardized strategy was significantly lower than the mean cost per patient of the open strategy (p<0.001). There were significantly fewer visits (p<0.001), fewer radiological procedures (p<0.004) and fewer laboratory investigations (p<0.001) in the standardized group.
CONCLUSION: A standardized strategy is a cost-saving approach for the etiological diagnosis of uveitis.