Cost Effectiveness of a Point-of-Care Test

for Adenoviral Conjunctivitis

EXECUTIVE SUMMARY
Health Economics Consulting Group, LLC
*

Contact: J ohn Schneider, PhD
E-mail: jeschneider@hecg-llc.com
Web: www.hecg-llc.com
March 2007


*
TheHealth Economics Consulting Group
LLC
is group of academic health economists and health services
researchers providing research consulting services in a number of subject areas in health economics, including cost
impact and cost-effectiveness analyses, patterns of care and estimates of treatment effects using claims data, and
economic impact of health sector regulation, including antitrust, managed care regulation, licensure and capacity
regulation, and administered pricing. For more information, visit www.hecg-llc.com. This project was funded in
part by an unrestricted educational grant from Rapid Pathogen Screening, Inc. to Health Economics Consulting
Group LLC.
Health Economics Consulting Group LLC Page 1 of 3
INTRODUCTION

Conjunctivitis is a relatively common condition of
the eye that occurs worldwide and affects all ages
and social strata.
1
More than 6 million US
residents suffer from conjunctivitis each year.
2-7

Approximately 3% of all emergency department
visits are ocular related, and of these,
conjunctivitis is indicated in 30% of cases.
8

Among patients visiting primary care physicians,
2% of all visits are for eye complaints with 54%
of these cases being diagnosed as conjunctivitis or
corneal abrasion.
9
Several studies have reported
that the majority of these cases-- as much as 2%
of all general practice consultations-- are cases of
acute infective conjunctivitis.
10-15
A meta-analysis
of six US studies indicates a prevalence of
adenovirus in approximately 36% of all cases of
acute conjunctivitis.
10-15
The main objective of this
research is to examine the cost effectiveness of a
point-of-service test for adenoviral conjunctivitis.
The model adopts an insurer (or payer)
perspective.


BACKGROUND

Due to its common occurrence, contagiousness,
and potentially debilitating symptoms,
conjunctivitis is an economic burden
worldwide.
16-19
The bulk of conjunctivitis-related
costs include physician consults, supportive care,
diagnostic tests, and lost productivity associated
with time away from work or school.
20

Misdiagnosed cases (approximately 50% of all
cases
21, 22
) may have substantially higher costs,
including repeat physician visits, additional
diagnostic testing, referrals to specialists, and
other medical costs associated with inappropriate
treatment.
23, 24
Misdiagnosis may also imply that
precautions were not taken to prevent the spread
of infection (especially in the case of viral
conjunctivitis), thereby adding additional cases
and costs.
*
Prescription antibiotic utilization
constitutes a large proportion of conjunctivitis
costs. Unnecessary or inappropriate prescription
of antibiotics is in part attributable to physician

*
Moreover, misdiagnosis of the causative agent of
conjunctivitis may lead to misdiagnoses of associated
morbidities or underlying systemic diseases
difficulties accurately discriminating between
viral and bacterial conjunctivitis. Consequently,
the standard of care for conjunctivitis, regardless
of causative agent, continues to be antibiotics
prescribed empirically. Over-utilization of
prescription drugs is likely to result in substantial
unnecessary costs, contribute to antibiotic
resistance, and expose patients to drug-related
topical allergies and toxicity.


METHODS

We performed a cost-effectiveness analysis
following conventional methodology.
18, 19, 25
The
interventions evaluated include the use of a rapid
point-of-care test (RPS Adeno Detector

,
hereafter referred to as AVD) for cases of acute
conjunctivitis (viral and bacterial) as compared to
no point of care test (NAVD). Baseline estimates
of testing, costs of treatment, condition and
treatment morbidities and disease event costs were
based on primary data sets,

published literature
and expert opinion. Prevalence data are
considered for the entire US. Positive costs
include: the unit costs of the AVD; the additional
costs of conservative therapy with correct
diagnosis; and the additional costs of an incorrect
diagnosis using the AVD when its sensitivity is
considered. Negative costs include: the costs of
unnecessary antibiotic therapy with correct
diagnosis;

the costs of unnecessary re-consults;

the costs of unnecessary referrals; the costs of
secondary transmitted infection; the costs of
unnecessary antibiotic morbidities; and the costs
of avoidable morbidity attributable to
misdiagnosis.

Rapid Pathogen Screening, Inc., www.rps-tests.com,

877-921-0080

The main primary data set was Medstat MarketScan

data, which represents 223,218 cases of conjunctivitis
in the commercially insured market.

The average cost of antibiotics prescribed was

determined by analyzing Verispan and Medstat data
from more than 223,218 insured lives.
Health Economics Consulting Group LLC Page 2 of 3
RESULTS

The results of the cost effectiveness analysis are
presented in Table 1. From the insurer perspective,
NAVD results in a cost per case of acute
conjunctivitis to society of $56.73. If the AVD is
used, there would be a cost of $34.22 per case of
acute conjunctivitis.

TABLE 1
Costs per Case and Aggregate Costs of Acute
Conjunctivitis with and without AVD
Cost per
case
($US)
Aggregate
Cost
($US)(a)
NAVD $56.73 $341,658,411
AVD $34.22 $206,091,148
Difference (b) $22.51 $135,567,263
% AVD Savings 39.68% 39.68%
Notes: (a) Based on a prevalence of acute
conjunctivitis of 6,022,535 nationally
2, 22, 26-28
;
(b) incremental cost savings based on CEA
model.

The NAVD-AVD difference represents a net
savings of $22.51 per case,
**
or about 40%. Based
on the prevalence of acute conjunctivitis nationally,
this savings translates to $136 million annually. In
addition, Medstat MarketScan data show an average
cost per episode of conjunctivitis care to be $194 in
the commercially insured market. This level is
considerably larger than our CEA estimate because
it is based on actual claims data for a 60-day period
following an initial diagnosis of conjunctivitis.
Thus, the Medstat episode cost of $194 is a more
accurate estimate of true costs in the commercially
insured market. At the 40% savings rate, insurers
could expect to save approximately $39 per case and
a total of $467 million annually.

The cost-saving properties of the AVD result in
relatively high price neutrality levels. Based on the
baseline estimate of prevalence of acute
conjunctivitis (91%; 6 million cases), price
neutrality is achieved at $47 per unit, dropping to
$36 per unit under the conservative 70% assumption
(Figure 1). Even under the conservative prevalence
assumption, the neutrality point exceeds the current
AVD unit price by $12 per unit, or 50%.

**
Also referred to as the incremental cost

FIGURE 1
Price Neutrality Thresholds by
Prevalence of Acute Conjunctivitis
$24 $24 $24
$47
$41
$36
$0
$10
$20
$30
$40
$50
91% 80% 70%
Prevalence of Acute Conjunctivitis
AVD Unit Price Price Neutral


CONCLUSIONS

Our findings strongly support the positive
economic benefits of the RPS Adeno Detector.
Using the well-supported baseline assumptions,
we find appropriate use of the RPS Adeno
Detector can reduce the costs of acute
conjunctivitis by 40%, mainly by reducing levels
of inappropriate antibiotic use and reducing
further local spread of the disease. These savings
translate to health insurer savings of as much as
$467 million annually. These results are robust to
changes in key baseline parameters and extensive
sensitivity analyses.

Health Economics Consulting Group LLC Page 3 of 3
REFERENCES

1. American Academy of Ophthamology.
Conjunctivitis 2003.
2. Medstat. MarketScan Commercial Claims and
Encounters Database; 2006.
3. Garrity J , Liesegang T. Ocular complications of
atopic dermatitis. Canadian Journal of
Ophthalmology. Feb 1984;19(1):21-24.
4. Rich L, Hanifin J . Ocular complications of atopic
dermatitis and other eczemas. International
Ophthalmology Clinics. Spring 1985;25(1):61-76.
5. Ronnerstam R, Persson K, Hansson H, Renmarker
K. Prevalence of chlamydial eye infection in
patients attending an eye clinic, a VD clinic, and in
health persons. British Journal of Ophthalmology.
May 1985;69(5):385-388.
6. Stenberg K, Mardh P. Genital infection with
Chlamydia trachomatis in patients with chlamydial
conjunctivitis: unexplained results. Sexually
Transmitted Diseases. J an-Mar 1991;18(1):1-4.
7. Rose P, Harnden A, Brueggemann A, et al.
Chloramphenicol treatment for acute infective
conjunctivitis in children in primary care: a
randomised double-blind placebo-controlled trial.
Lancet. J uly 2-8 2005;366(9479):37-43.
8. Silverman M, Bessman E. Conjunctivitis.
http://www.emedicine.com/emerg/topic110.htm.
Accessed J anuary 20, 2006.
9. Shields T, Sloane PD. A Comparison of Eye
Problems in Primary Care and Opthalmology
Practices. Chapel Hill: Department of Family
Medicine, The University of North Carolina
School of Medicine.
10. Wilson A. The Red Eye: A General Practice
Survey. Journal of the Royal College of General
Practice. 1987;37:62-64.
11. Dart J. Eye Disease at a Community Health
Centre. British Medical Journal. 1986;293:1477-
1480.
12. McDonnell P. How Do General Practitioners
Manage Eye Disease in the Community? British
Journal of Opthalmology. 1988;72(10):733-776.
13. Sheldrick J , Vernon S, Wilson A. Study of
Diagnostic Accord Between General Practitioners
and an Opthalmologist. British Medical Journal.
1992;304:1096-1098.
14. Sheldrick J , Wilson A, Vernon S, Sheldrick C.
Management of Opthalmic Disease in General
Practice. British Journal of General Practice.
November 1993 1993;43(376):459-462.
15. Royal College of General Practitioners,
Opthamologists RCo. Opthalmology for General
Practice Trainees. London: Medical Protection
Society; 2001.
16. American Optometric Association. Care of the
Patient with Conjunctivitis. St Louis 2002.
17. Folland S, Goodman AC, Stano M. The Economics
of Health and Health Care. New J ersey: Prentice
Hall; 2001.
18. Gold MR, Seigel J E, Russell LF, Weinstein MC.
Cost-Effectiveness in Health and Medicine. New
York: Oxford University Press; 1996.
19. Drummond MF, O'Brien B, Stoddart GL, Torrance
GW. Methods for the Economic Evaluation of
Health Care Programmes. Oxford: Oxford
University Press; 1997.
20. Piednoir E, Bureau-Chalot F, Merle C,
Gotzamanis A, Wuibout J , Gajolet O. Direct costs
associated with a noscomial outbrak of adenoviral
conjunctivits infection a long-term care institution.
American Journal of Infection Control.
2002;30(7):407-410.
21. Mahajan V. Acute Bacterial Infections of the Eye:
Their Aetiology and Treatment. British Journal of
Opthalmology. 1983;67:191-194.
22. Stenson S, Newman R, Fedukowicz H. Laboratory
studies in acute conjunctivitis. Archives of
Opthamology. 1982;100(8):1275-1277.
23. Rietveld RP, van Weert HC, ter Riet G, Bindels
PJ . Diagnositic impact of signs and symptoms in
acute infectious conjunctivitis: systematic
literature search. British Medical Journal.
2003;327:789.
24. Little P, Gould C, Williamson I, Warner G,
Gantley M, Kinmouth A. Reattendance and
Complications in a Randomised Trial of
Prescribing Strategies for Sore Throat: The
Medicalising Effect of Prescribing Antibiotics.
British Medical Journal. 1997;315:350-352.
25. Drummond MF, McGuire A. Economic
Evaluation in Health Care: Merging Theory with
Practice. New York: Oxford University Press;
2001.
26. Gigliotti F, Williams WT, Hayden FG. Etiology of
acute conjunctivitis in children. Journal of
Pediatrics. 1981;98:531-536.
27. Fitch CP, Rapoza PA, Owens S. Epidemiology and
diagnosis of acute conjunctivitis at an inner-city
hospital. Ophthalmology. 1989;96:1215-1220.
28. Weiss A, Brinser J , Nazar-Stewart V. Acute
Conjunctivitis in Childhood. Journal of Pediatric
Medicine. 1993;122(1):10-14.