The cost-effectiveness of upfront point-of-care testing in the emergency department: a secondary analysis of a randomised, controlled trial

Lara Nicole Goldstein, Mike Wells, Craig Vincent-Lambert, Lara Nicole Goldstein, Mike Wells, Craig Vincent-Lambert

Abstract

Background: Time-saving is constantly sought after in the Emergency Department (ED), and Point-of-Care (POC) testing has been shown to be an effective time-saving intervention. However, when direct costs are compared, these tests commonly appear to be cost-prohibitive. Economic viability may become apparent when the time-saving is translated into financial benefits from staffing, time- and cost-saving. The purpose of this study was to evaluate the cost-effectiveness of diagnostic investigations utilised prior to medical contact for ED patients with common medical complaints.

Methods: This was a secondary analysis of data from a prospective, randomised, controlled trial in order to assess the cost-effectiveness of upfront, POC testing. Eleven combinations of POC equivalents of commonly-used special investigations (blood tests (i-STAT and complete blood count (CBC)), electrocardiograms (ECGs) and x-rays (LODOX® (Low Dose X-ray)) were evaluated compared to the standard ED pathway with traditional diagnostic tests. The economic viability of each permutation was assessed using the Incremental Cost Effectiveness Ratio and Cost-Effectiveness Acceptability Curves. Expenses related to the POC test implementation were compared to the control group while taking staffing costs and time-saving into account.

Results: There were 897 medical patients randomised to receive various combinations of POC tests. The most cost-effective combination was the i-STAT+CBC permutation which, based on the time saving, would ultimately save money if implemented. All LODOX®-containing permutations were costlier but still saved time. Non-LODOX® permutations were virtually 100% cost-effective if an additional cost of US$50 per patient was considered acceptable. Higher staffing costs would make using POC testing even more economical.

Conclusions: In certain combinations, upfront, POC testing is more cost-effective than standard diagnostic testing for common ED undifferentiated medical presentations - the most economical POC test combination being the i-STAT + CBC. Upfront POC testing in the ED has the potential to not only save time but also to save money.

Trial registration: ClinicalTrials.gov: NCT03102216.

Keywords: Economic analysis; Emergency department; Point-of-care systems; Point-of-care testing.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The POC intervention workflows compared to the normal ED patient workflow
Fig. 2
Fig. 2
a Cost Effectiveness Plane. Permutations in the south-east quadrant were less costly and more effective (also referred to as dominant) [13]. Permutations in the north-east quadrant were still more effective but were also costlier. b Cost-Effectiveness Acceptability Curve. Cost-effectiveness acceptability curves for each of the permutations. The proportion of the bootstrap datapoints achieving cost-effectiveness at each increment of potentially acceptable cost is shown. Permutations which included LODOX® are shown with dashed lines. The dotted lines represent two potential willingness-to-pay thresholds. For example, at US$50, virtually all the non-LODOX® permutations have a high probability of being cost-effective. On the other hand, at a willingness-to-pay threshold of US$30, only the iSTAT and the ECG permutations have a high probability of being cost-effective. This graph allows the funder to weigh the relative cost of each of the permutations against their known effectiveness. CBC Complete Blood Count, ECG electrocardiogram, i-STAT i-STAT POC tests, LODOX® Low-dose x-ray

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Source: PubMed

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