John Bartlett, MD


July 23, 2003

In This Article

Cost-effectiveness of the ID Consult

Petrak RM, Sexton DJ, Butera ML, et al. The value of an infectious diseases specialist. Clin Infect Dis. 2003;36:1013-1017. Abstract This report from 13 infectious disease specialists reviews information relevant to the specialty's contribution in clinical practice. Here are their observations:

  • Previous studies: A study from Duke indicated the overall rate of consultations was 2.1% to 4.1% of inpatients,[8] but a later study showed a rate of 6%.[9]).

  • Sepsis: ID consultation for bacteremia reduced mortality, morbidity, and total cost in 6 studies.[10,11,12,13,14,15]

  • Nathwani and colleagues[15] showed consults for bacteremia requested antibiotic changes in 50%, with an overall cost savings.

  • A study from Spain showed better antibiotic selection and outcome with ID consults in bacteremic patients.[13]

  • Infection control: The estimated annual cost of an infectious disease program per life saved is $2000-8000, which might be compared to other standard practices such as cholesterol reduction at $32,500 per life saved, or mammograms for women 50-60 years at $130,000 per life saved.

  • Outpatient antibiotic therapy: Multiple studies have documented cost-benefit.[16,17,18]

  • Antibiotic controls: The proper term now is "antimicrobial stewardship."

  • Development of clinical practice guidelines

  • Directive care in teaching: This refers to the role of the ID consultant in managing or consulting on highly complex cases. It also includes the role of the ID consultant as a teacher.

Comment: The article might appear to be self-serving, but this is a characteristic of most medical specialties that undertake the challenge of defining their importance. Somewhat surprising in this review is the failure to acknowledge the role of the ID consultant in the care of persons with HIV/AIDS. The previous studies indicate that approximately 40% of such patients are managed by ID-trained physicians, and multiple studies demonstrate that expertise (defined by patient panel size rather than specialty) shows significant benefit in terms of mortality, morbidity, rates of hospitalization, cost-effectiveness, and compliance with guidelines. Another major role that is missing is the work done by ID clinicians in the context of bioterrorism preparedness.


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