Cost-effectiveness of HSV PCR testing in febrile infants

1. Methods Abstract Results • Decision analysis using DATA • Decision tree modeling of the three treatment options, from presentation to discharge from the hospital • Variable input: costs, probabilities, utilities • Data sources include national-representative databases and the existing medical literature on HSV, EV, and treatment of febrile infants. • Costs: daily costs and length of stay will be estimated using national-representative databases such as 2006 KID. Treatment and testing costs will be obtained from existing medical papers. • Probabilities: probabilities of having HSV, EV, or a bacterial infection and probabilities of various outcomes will be obtained from national-representative databases such as 2006 KID as well as existing medical papers. • Utilities: utilities of surviving with a disability from HSV, EV, or bacterial infection will be obtained from existing medical papers. • Figure 1 represents our cost-effectiveness model. • Costs related to HSV testing are shown in Table 1, probabilities in Table 2, and utilities in Table 3. • Background. Herpes simplex virus (HSV) is a rare but potentially devastating cause of fever in newborn infants. A new diagnostic test for HSV has been recently developed and has significantly shortened the time to confirm diagnosis of HSV infection. The most cost-effective use of this treatment with regard to the management of febrile infants is not known. • Objectives. We will use cost-effectiveness analysis to assess three treatment proposals: No use of test, use of test on all febrile infants, selective use of test on febrile infants. • Methods. We will build a decision tree in DATA modeling the costs, probabilities, and utilities related to the three proposed treatment options. The values for cost, probability, and utility variables will be taken from national-representative databases and the existing medical literature. • Results. A decision tree has been modeled, but we are still finalizing data collection and analyses. • Conclusions. No conclusions have been made, however, we hypothesize that the selective use of this new test will prove to be most cost-effective. Such findings would change the way in which febrile infants are managed at presentation. Background • Herpes simplex virus (HSV) is a rare but potentially devastating cause of fever in newborn infants, leading to prolonged hospitalizations, long-term neurologic injury, or death. • In 1998 a new diagnostic test for HSV was developed based on polymerase-chain reaction technology (PCR). • This new test shortened the time to confirm the diagnosis of viral illness from 1-2 weeks to 1-3 days . • The use of this test, however, continues to be highly variable both across and within hospitals. This variability leads to confusion for parents and patients and may result in either • (1) unnecessary health care costs and painful tests or • (2) missed diagnoses and undertreatment. Policy Implications Objectives Use cost-effectiveness analysis to weigh the benefits with the added (or reduced) costs of three different treatment proposals: • No use of PCR test for any patient (pre-PCR base scenario) • Use of PCR test for all eligible patients, here any child under 1 year of age with a fever • Selective use of PCR test in this group of children Cost-effectiveness of HSV PCR testing in febrile infants Lorch SA1, 2, Murillo SN2 1Center for Outcomes Research, Dept of Pediatrics, The Children’s Hospital of Philadelphia 2Leonard Davis Institute of Health Economics, University of Pennsylvania Figure 1: Decision Tree Table 1: Table of Input Costs for HSV-2 Testing Table 2: Table of Input Probabilities for HSV-2 Table 3: Utility Values for Outcomes of HSV-2 • We hypothesize that the selective use of this new test will prove to be most cost-effective. Though such results would lead to an increase in initial treatment costs, the improved outcomes should result in lower long-term health care costs and improved outcomes. As a result, such findings would change the way in which febrile infants are managed at presentation.