Objectives

Primary immunodeficiency diseases (PID) include over 300 disorders caused by genetic defects of immune system. Despite associated high mortality and disease burden, clinically it is common to see missed and delayed diagnosis due to lack of clinical awareness and tests, which poses a great challenge in China. This study focused to estimate the budget impact of applying one recommended-diagnostic-technology flow cytometry (FCM) in demonstrating the value of early case-finding strategy.

Methods

An Excel-based budget impact model was constructed from the healthcare-provider perspective with a three-year time horizon. Targeting PID suspects with infection-related symptoms, the model examined clinical and economic outcomes of case-finding strategy by FCM compared with no-FCM. Direct medical cost included the necessary diagnosis and treatment for diagnosed PID patients and undiagnosed cases as infection-related diseases. Transition probability parameters and costs were collected from literature review, statistic yearbook, and expert opinions.

Results

Compared with no-FCM strategy, FCM strategy identified 213 more PID patients and had a higher diagnostic cost by 7,033,427 CNY due to additional FCM tests in suspects. The total cost was considerably lower for FCM strategy due to avoided repeated infections, clinical adverse events, and premature deaths, by a total 9,977,193 CNY in the three years. The costs associated with the undiagnosed PID patients were significantly higher than the early diagnosed cases, particularly in no-FCM strategy.

Conclusions

Early case-finding strategy with the application of FCM in PID suspects appears to be able to achieve better clinical outcomes such as avoided clinical events and averted premature mortality and better economic benefits with overall cost saving.