Hospitalized patients who are tested for antimicrobial susceptibility have significantly lower mortality rates, lower lengths of stay and lower overall treatment costs than patients who are not tested.

These are the findings of a report released yesterday by the Advanced Medical Technology Association (AdvaMed; Washington), which is pushing for the improved testing measures and increases in reimbursement that go with it.

“Widespread testing for drug-resistant infections is a small investment that yields high returns for patients, for hospitals and for the healthcare system overall,” said report author Frank Lichtenberg, PhD, the Courtney C. Brown professor of business at the Columbia University Graduate School of Business, (New York), during a conference call yesterday.

The key word here was “investment,” with AdvaMed using the call to highlight its pursuit of better reimbursement for these new tests — of course a concern for the association’s member companies that make such tests.

If there is uncertainty about whether a patient’s pathogen is resistant to antimicrobial agents, tests that reveal the susceptibility of the pathogen can allow physicians to administer more appropriate and effective treatments.

Plus, the emergence of new, rapid and highly accurate diagnostic technologies has provided an opportunity for healthcare to move from the traditional approach of providing broad-spectrum antibiotic therapy to patients with any infection, to a more focused, specific treatment based on a linkage between the actual characteristics of the targeted organism and the antibiotic drug most suitable to eliminate it, according to the report.

In an effort to gain control over the increase of drug-resistant infections and the associated costs, AdvaMed sponsored the report in an effort to help physicians more effectively treat patients with staphylococcal and other infectious diseases, such as HIV and tuberculosis.

The potential impact of testing for drug-resistant infections is significant as the number of U.S. hospital discharges that include a diagnosis of infection with a drug-resistant microorganism has ballooned more than 100-fold, from 3,000 in 1995 to 394,000 in 2005.

Lichtenberg conducted an econometric analysis of the impact of antimicrobial susceptibility testing on the survival, length of stay, and treatment costs of inpatients with staphylococcal infections, based on a large sample of U.S. hospital admissions during 2004 – 2005.

He looked at patients with a secondary diagnosis related to a staph infection and patients with any infectious and parasitic disease diagnosis as a primary or secondary diagnosis. The benefits outlined in his report don’t include the use of some of the newest technologies available.

“My sample and data don’t include the new rapid tests,” he said. “They are based on non-rapid tests used in this period [2004-2005].”

“The industry faces challenges in the reimbursement system, which is based on technology that existed 20 years ago and doesn’t take into account the outcomes for the patient,” said Stephen Sichak, Jr., president of BD Diagnostics (Franklin Lakes, New Jersey), who participated in the conference call to discuss the report.

Lichtenberg said that among patients with a secondary staph infection diagnosis, those tested for antimicrobial susceptibility had 52% lower probability of death before discharge, a 17% lower mean length of stay, and 22% lower cost than those who did not.

Antimicrobial testing in this group also was associated with $6,978 lower cost per discharge. The potential cost reduction from antimicrobial susceptibility testing of all patients hospitalized with this diagnosis in 2005 was $8.3 billion.

He also said that among patients with any infectious and parasitic disease diagnosis, those tested for antimicrobial susceptibility had 30% lower probability of death before discharge, 26% lower mean length of stay, and 36% lower cost than those who did not. Antimicrobial susceptibility testing in this group was associated with $7,524 lower cost per discharge.

Also participating in the call, David Persing, MD, PhD, executive VP, chief medical and technology officer of Cepheid (Sunnyvale, California), along with Sichak, discussed current diagnostic technologies used to identify drug-resistant and hospital-acquired infections and areas of future innovation. They outlined advances in rapid testing and the opportunities today for genotype-based diagnostics that take minutes or hours to produce a finding, compared to days required by traditional phenotype-based tests that require culturing.

“These [new] technologies are the foundation of the personalized medicine revolution that match the best treatment option with each individual patient,” said Stephen Ubl, president/CEO of AdvaMed. “State-of-the-art diagnostic testing will help dramatically lower healthcare costs by eliminating unnecessary or ineffective treatments, but more importantly providing patients with the right treatment sooner.”

“But patient access to this advanced technology is limited by an outdated Medicare payment system,” said Seth Radus, VP, government affairs, for AdvaMed. “The current fee schedule doesn’t incorporate the value of molecular tests.”

Radus said AdvaMed is now working to introduce legislation that would change the way Medicare pays for molecular testing.