Effectiveness and cost of quick diagnostic tests to determine tetanus immunity in patients with a wound in french emergency departmentsReportar como inadecuado




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BMC Infectious Diseases

, 14:603

Vaccines

Abstract

BackgroundTétanos Quick Stick® TQS is a test for tetanus immunity screening for wounded patients in emergency departments EDs, but represents additional costs compared with a medical interview on vaccination history. The study objective was to assess the effectiveness and cost of the TQS in French EDs.

MethodsWe performed a model-based analysis that simulates screening of tetanus immunity and risk of tetanus based on prophylaxis administration. Strategies compared were: i diagnosis of tetanus immunity by -TQS-; ii -Medical Interview- current practice. The study population was 1,658,000 French adults seeking ED care for a wound in 2012. Model parameters were estimated based on French national surveillance data, and published literature. Outcome measures were number of tetanus cases, life years gained and costs 2012 € from a societal perspective.

ResultsUse of TQS had negligible impact on health outcomes 0.02 tetanus cases-year in France vs. 0.41 for -Medical Interview-, but resulted in a decrease in annual costs of €2,203,000 -42%. Base case and sub-group analysis showed that with the same effectiveness, the average cost per patient was: €13 with -Medical Interview- vs. €11.7 with TQS for the overall cohort; €28.9 with -Medical Interview- vs. €21 with -TQS- for tetanus-prone wounds; €15 with -Medical Interview- vs. €14.1 with -TQS- for patients aged ≥65 years; and €6.2 with -Medical Interview- vs. €7.8 with -TQS- for non-tetanus-prone wounds.

ConclusionsUse of TQS is as effective and less costly than -Medical Interview- when applied in ED to wounded patients with tetanus-prone wounds or aged ≥65 years. However, it is more expensive in patients with non-tetanus-prone wounds.

KeywordsTetanus immunity Diagnostic tests Cost-effectiveness Emergency department AbbreviationscCost

EDEmergency Department

FNFalse Negative

FPFalse Negative

GPGeneral practitioner

ICERIncremental cost effectiveness ratio

LYLife years

LYGLife Years Gained

NCohort size

NPVNegative predictive value

PrProbability

PPVPositive predictive value

TQSTétanos Quick Stick®

TIGTetanus immunoglobulin

TNTrue Negative

TPTrue Positive

│Among in case of a conditional probabilities

Electronic supplementary materialThe online version of this article doi:10.1186-s12879-014-0603-3 contains supplementary material, which is available to authorized users.

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