Economic Evaluation: Onsite HSV PCR Capabilities for Pediatric Care

Area of Science:

• Infectious Diseases
• Clinical Diagnostics
• Health Economics

Background:

• Herpes simplex virus (HSV) encephalitis carries a significant mortality rate, necessitating prompt diagnosis and treatment.
• Current diagnostic methods for HSV often involve external laboratories, leading to delays in results.
• These delays can prolong empiric treatment, increase hospital stays, and escalate healthcare costs, particularly in vulnerable populations like neonates.

Purpose of the Study:

• To evaluate the impact of implementing onsite HSV PCR testing on hospitalization duration, acyclovir treatment duration, and overall hospital costs.
• To compare the efficiency and cost-effectiveness of in-house PCR testing versus traditional third-party laboratory services for HSV diagnosis.

Main Methods:

• A single-center study employing the IHI model for improvement.
• Comparison of outcomes between patients tested via offsite third-party HSV PCR and those tested using an onsite PCR-based meningitis-encephalitis panel.
• Analysis of primary outcome (hospital cost differential) and secondary outcomes (acyclovir administration duration, time to result).

Main Results:

• Onsite HSV PCR testing resulted in a per-patient cost saving of $428.
• The mean duration of acyclovir therapy decreased significantly from 3.7 to 0.26 days (P < 0.001).
• Time to result was dramatically reduced from 4.6 to 0.13 days (P < 0.001) with onsite testing.

Conclusions:

• Real-time, local HSV PCR capabilities substantially decrease diagnostic turnaround times.
• Implementation of onsite testing significantly reduces the duration of empiric medication use, such as acyclovir.
• Onsite HSV PCR testing leads to significant reductions in hospital costs within a healthcare facility.