Aim Development of a model to assess changes in
diagnostic procedures and treatment in patients with meningeal signs in terms
of survival, quality-adjusted-life-years (QALYs) and costs.
Methods The model was
developed on a large database of 360 children with ‘meningeal signs’ (0.08–15.0
years), visiting the emergency department of the Sophia Children’s Hospital
between 1988-1998. Additional data on probabilities of meningitis and adverse
outcome, costs and quality weights (utilities) were derived from literature,
database and national registries. The time-horizon of the model was 15 years.
Results: 99 children had
bacterial meningitis (10 with adverse outcome), 36 other serious bacterial
infections and 225 self-limiting diseases. Mean costs per patient were 8393
Euro (65% associated with long-term neurological sequelae). The mean number of
QALYs was 11.19. A diagnostic decision rule to minimise lumbar punctures and
empirical antibiotic treatment, without missing one case of meningitis, reduced
total costs by 4%. Misdiagnosis of bacterial meningitis resulted in a strong
increase of costs of neurological sequelae and a strong reduction of QALYs. A
vaccination strategy achieving a 50% reduction of bacterial meningitis reduced
costs with 40% and increased QALYs with 1.6%.
Conclusion Costs of long-term
neurological sequelae predominate the costs of initial diagnosis and treatment.
Misdiagnosing of bacterial meningitis leads to a strong increase in costs and a
loss of QALYs. The model can contribute to the cost-effectiveness analysis of
vaccination strategies, incorporating the long term costs and quality of life.