Inter-hospital variation in resource utilization of diagnostic and follow-up biomarkers in adult community-acquired pneumonia

Introduction: In value-based healthcare, optimal patient outcomes are pursued with optimal use of care. Aims and objectives: Our aim was to assess the inter-hospital variation in resource utilization of diagnostic and follow-up biomarkers in adult community-acquired pneumonia, to fuel discussions about achieving optimal outcomes for the lowest cost. Methods: This study was conducted in the mid-trial population of a Dutch multicenter placebo-controlled trial, investigating dexamethasone as adjunctive treatment for community-acquired pneumonia. All charged care items were captured, filtered on diagnostic and follow-up biomarkers and subsequently categorized. Average numbers of items and costs were calculated. Analyses were limited to the top 5 items per category that were utilized u003e10% of the patients. Results: Mean costs for clinical chemistry testing ranged from 25 to 49 euros per patient between hospitals. For radiology exams the range was from 87 to 118 euros. The costs for microbiology testing showed the most inter-hospital variation with a mean difference of 531 euros per patient. The cost-driver behind this difference was the amount of PCR testing. Conclusions: Our findings suggests that cost savings may be achieved through standardization of microbiology testing. Further investigation is needed to explore the optimal set of diagnostic testing in relation to clinical outcomes.