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. 2014 Nov 19:14:603.
doi: 10.1186/s12879-014-0603-3.

Effectiveness and cost of quick diagnostic tests to determine tetanus immunity in patients with a wound in French emergency departments

Dieynaba S N'Diaye, Michaël Schwarzinger, Dorothée Obach, Julien Poissy, Sophie Matheron, Enrique Casalino, Yazdan Yazdanpanah

Effectiveness and cost of quick diagnostic tests to determine tetanus immunity in patients with a wound in French emergency departments

Dieynaba S N'Diaye et al. BMC Infect Dis. .

Abstract

Background: Tétanos 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.

Methods: We 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.

Results: Use 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.

Conclusions: Use 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.

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Figures

Figure 1
Figure 1
Decision-tree model: strategies compared and sub-trees. TQS: Tétanos Quick Stick; TP: True Positive; FP: False Negative; TN: True Negative; FN: False Negative (A) True Positive sub-tree; (B) True Negative sub-tree; (C) False Positive sub-tree; (D) False Negative sub-tree; *For non-tetanus-prone wound; # For tetanus-prone wound.
Figure 2
Figure 2
Tornado analysis on strategy incremental costs: incremental cost of the “TQS” strategy compared with the “Medical Interview” strategy (in 2012 Million euros). TQS: Tétanos Quick Stick; TIG: Human tetanus immunoglobulins.
See this image and copyright information in PMC

References

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