Journal Article

Evaluating the cost-consequence of a standardized strategy for the etiological diagnosis of uveitis (ULISSE study)

Tieulié, Nathalie, Manoli, Pierre, Bicêtre Hospital, CHU Rouen ; Normandie Université (NU), Bodaghi, Bahram, Cornut, Pierre-Loic, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Pugnet, Grégory, Baillif, Stéphanie, Centre Hospitalier Universitaire de Nice (CHU Nice), Chiambaretta, Fédéric, Ulisse, Bienvenu, Boris, Hospices Civils de Lyon (HCL), The French Ministry of Health (PHRC 2009), Desgenettes Hospital ; Partenaires INRAE, Rabelais Center ; Partenaires INRAE, La Conception, Hôpital Nantes ; Partenaires INRAE, Sève, Pascal, Service d'Ophtalmologie (CHU de Dijon) ; Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Kodjikian, Laurent, Mouriaux, Frédéric, André, Marc, Sedira, Neila, CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie (CHU Caen Normandie) ; Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Ollé, Priscille, Service de Médecine Interne (SOC 1 et SOC 2) [CHU de Dijon] ; Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterr

2020

Overview

MAIN OBJECTIVE: To prospectively assess the cost-consequence of a standardized diagnostic strategy as to compared to an open one for the etiological diagnosis of uveitis. DESIGN: This was a prospective, non-inferiority, multicentre, randomized controlled trial. METHODS: We included all consecutive patients with uveitis who had visited at least one of the Departments of Ophthalmology. In the standardized group, patients had a minimal work-up regardless of the type of uveitis (including evaluation of the CBC, ESR, C-reactive protein, tuberculin skin test, syphilis serology and chest X-ray). Depending on ophthalmological findings, further investigations could be performed. In the open strategy, ophthalmologists were free to order any kind of investigation. The main outcome was the mean cost per patient of each strategy. RESULTS: 903 uveitis patients were included from January, 2010 to May, 2013. The mean cost per patient of the standardized strategy was 182.97 euros [CI 95% (173.14; 192.80)], and the mean cost per patient of the open strategy was 251.75 euros [CI 95% (229.24; 274.25)]. Therefore, the mean cost per patient of the standardized strategy was significantly lower than the mean cost per patient of the open strategy (p<0.001). There were significantly fewer visits (p<0.001), fewer radiological procedures (p<0.004) and fewer laboratory investigations (p<0.001) in the standardized group. CONCLUSION: A standardized strategy is a cost-saving approach for the etiological diagnosis of uveitis.

• Publisher: CCSD,Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Antibiotics / Biology and Life Sciences / C-reactive protein / Comparative analysis / Control methods / Cost control / Diagnosis / Diagnostic systems / Diagnostic tests / Drug dosages / Economic aspects / Endoscopy / Etiology / Evaluation / Female / France / Hospitals / Human health and pathology / Humans / Internal medicine / Laboratories / Life Sciences / Male / Medical diagnosis / Medical personnel / Medical tests / Medicine / Medicine and Health Sciences / Microsurgery / Middle Aged / Ophthalmologists / Ophthalmology / Ophthalmology - economics / Ophthalmology - standards / Patients / Physicians / Practice Patterns, Physicians' - economics / Practice Patterns, Physicians' - standards / Prospective Studies / Research and Analysis Methods / Sensory Organs / Serology / Sexually transmitted diseases / Skin / Skin tests / STD / Strategy / Syphilis / Tariffs / Tuberculin / Uveitis / Uveitis - diagnosis / Uveitis - economics / Uveitis - etiology
• ISBN: 0005352066000