{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T18:29:16Z","timestamp":1781288956892,"version":"3.54.1"},"reference-count":54,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DiaSorin SpA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: We aimed to estimate the economic and clinical impacts of a novel diagnostic test called LIAISON\u00ae MeMed BV\u00ae (LMMBV), which can differentiate bacterial from viral infections, in patients with community-acquired pneumonia (CAP) in emergency departments. Methods: A cost-impact simulation model was developed to investigate the financial consequences of the introduction of LMMBV into the standard of care (SOC) diagnostic process in Italy, Germany, and Spain. Clinical outcomes were expressed as antibiotic patients and days saved, reduced hospital admissions, and shortened hospital length of stay (LOS). Cost savings were evaluated from the perspectives of third-party payers and hospitals. A deterministic sensitivity analysis (DSA) was carried out. Results: LMMBV was associated with a reduction in antibiotic prescriptions, treatment duration, and LOS. Furthermore, the adoption of LMMBV would allow savings per patient up to EUR 364 and EUR 328 for hospitals and EUR 91 and EUR 59 for payers in Italy and Germany, respectively. In Spain, average savings per patient could reach up to EUR 165 for both payers and hospitals. Savings were most sensitive to test accuracy, with DSA confirming the robustness of the results. Conclusions: Combining LMMBV with the current SOC diagnostic process is expected to provide clinical and economic benefits in Italy, Germany, and Spain.<\/jats:p>","DOI":"10.3390\/ijerph20053853","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T02:57:38Z","timestamp":1677034658000},"page":"3853","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Cost-Impact Analysis of a Novel Diagnostic Test to Assess Community-Acquired Pneumonia Etiology in the Emergency Department Setting: A Multi-Country European Study"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5208-2499","authenticated-orcid":false,"given":"Hirad","family":"Houshmand","sequence":"first","affiliation":[{"name":"DiaSorin SpA, Via Crescentino, 13040 Saluggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8402-6934","authenticated-orcid":false,"given":"Camilla","family":"Porta","sequence":"additional","affiliation":[{"name":"AdRes Health Economics and Outcomes Research, 10121 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Pradelli","sequence":"additional","affiliation":[{"name":"AdRes Health Economics and Outcomes Research, 10121 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pinciroli","sequence":"additional","affiliation":[{"name":"DiaSorin SpA, Via Crescentino, 13040 Saluggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1600-4474","authenticated-orcid":false,"given":"Giovanni","family":"Sotgiu","sequence":"additional","affiliation":[{"name":"Scienze Mediche Chirurgiche E Sperimentali, Universit\u00e0 degli Studi di Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/S0140-6736(21)00630-9","article-title":"Community-acquired pneumonia","volume":"398","author":"Aliberti","year":"2021","journal-title":"Lancet"},{"key":"ref_2","unstructured":"World Health Organization (2022, October 17). The Top 10 Causes of Death\u2014Factsheet. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1183\/09031936.00105513","article-title":"Respiratory health and disease in Europe: The new European Lung White Book","volume":"42","author":"Gibson","year":"2013","journal-title":"Eur. Respir. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1007\/s12325-020-01248-7","article-title":"Burden of Community-Acquired Pneumonia and Unmet Clinical Needs","volume":"37","author":"Sarda","year":"2020","journal-title":"Adv. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.rmed.2016.10.015","article-title":"Burden and risk factors of ambulatory or hospitalized CAP: A population based cohort study","volume":"121","author":"Kolditz","year":"2016","journal-title":"Respir. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/s-0029-1202941","article-title":"Global and Local Epidemiology of Community-Acquired Pneumonia: The Experience of the CAPNETZ Network","volume":"30","author":"Welte","year":"2009","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rivero-Calle, I., Pardo-Seco, J., Aldaz, P., Vargas, D.A., Mascar\u00f3s, E., Redondo, E., D\u00edaz-Maroto, J.L., Linares-Rufo, M., Fierro-Alacio, M.J., and Gil, A. (2016). Incidence and risk factor prevalence of community-acquired pneumonia in adults in primary care in Spain (NEUMO-ES-RISK project). BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1974-4"},{"key":"ref_8","unstructured":"(2022, October 17). Eurostat\u2014Ageing Europe\u2014Statistics on Population Developments. Available online: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=Ageing_Europe_-_statistics_on_population_developments."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1136\/thoraxjnl-2013-204282","article-title":"Risk factors for community-acquired pneumonia in adults in Europe: A literature review","volume":"68","author":"Torres","year":"2013","journal-title":"Thorax"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1080\/13696998.2022.2026686","article-title":"Cost impact analysis of novel host-response diagnostic for patients with community-acquired pneumonia in the emergency department","volume":"25","author":"Schneider","year":"2022","journal-title":"J. Med. Econ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/thx.2009.129502","article-title":"Clinical and economic burden of community-acquired pneumonia among adults in Europe","volume":"67","author":"Welte","year":"2012","journal-title":"Thorax"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and Treatment of Adults with Community-Acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America","volume":"200","author":"Metlay","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2010700","DOI":"10.1001\/jamanetworkopen.2020.10700","article-title":"Prevalence of Clinical Signs within Reference Ranges among Hospitalized Patients Prescribed Antibiotics for Pneumonia","volume":"3","author":"Klompas","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_14","unstructured":"(2022, October 18). DiaSorin LIAISON\u00ae MeMed BV\u00ae. Available online: https:\/\/www.diasorin.com\/it\/immunodiagnostica\/aree-cliniche\/malattie-infettive\/liaisonr-memed-bvr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1007\/s10096-018-3261-3","article-title":"A host-protein signature is superior to other biomarkers for differentiating between bacterial and viral disease in patients with respiratory infection and fever without source: A prospective observational study","volume":"37","author":"Oved","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.diagmicrobio.2017.11.011","article-title":"A novel host-protein assay outperforms routine parameters for distinguishing between bacterial and viral lower respiratory tract infections","volume":"90","author":"Stein","year":"2018","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Oved, K., Cohen, A., Boico, O., Navon, R., Friedman, T., Etshtein, L., Kriger, O., Bamberger, E., Fonar, Y., and Yacobov, R. (2015). A Novel Host-Proteome Signature for Distinguishing between Acute Bacterial and Viral Infections. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0120012"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e20163453","DOI":"10.1542\/peds.2016-3453","article-title":"Validation of a Novel Assay to Distinguish Bacterial and Viral Infections","volume":"140","author":"Srugo","year":"2017","journal-title":"Pediatrics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S1473-3099(16)30519-9","article-title":"A host-protein based assay to differentiate between bacterial and viral infections in preschool children (Opportunity): A double-blind, multicentre, validation study","volume":"17","author":"Klein","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1056\/NEJMoa1500245","article-title":"Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults","volume":"373","author":"Jain","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e180243","DOI":"10.1001\/jamanetworkopen.2018.0243","article-title":"Outpatient Antibiotic Prescribing for Acute Respiratory Infections during Influenza Seasons","volume":"1","author":"Havers","year":"2018","journal-title":"JAMA Netw. Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1053\/rmed.1999.0774","article-title":"Community-acquired pneumonia: Development of a bedside predictive model and scoring system to identify the aetiology","volume":"94","author":"Falguera","year":"2000","journal-title":"Respir. Med."},{"key":"ref_23","unstructured":"(2022, September 12). A Novel, Rapid Host-Response Test Permits Accurate Differentiation of Bacterial and Viral Infection in Febrile Ambulatory Patients: Apollo Study, Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/record\/NCT04690569."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1056\/NEJM199701233360402","article-title":"A Prediction Rule to Identify Low-Risk Patients with Community-Acquired Pneumonia","volume":"336","author":"Fine","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.1002\/jhm.414","article-title":"Incidence and impact of adverse effects to antibiotics in hospitalized adults with pneumonia","volume":"4","author":"Lin","year":"2009","journal-title":"J. Hosp. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Zhang, S., Palazuelos-Munoz, S., Balsells, E.M., Nair, H., Chit, A., and Kyaw, M.H. (2016). Cost of hospital management of Clostridium difficile infection in United States\u2014A meta-analysis and modelling study. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1786-6"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1001\/jamainternmed.2017.1938","article-title":"Association of Adverse Events with Antibiotic Use in Hospitalized Patients","volume":"177","author":"Tamma","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jinf.2016.04.008","article-title":"Risk factors for Clostridium difficile infection in hospitalized patients with community-acquired pneumonia","volume":"73","author":"Chalmers","year":"2016","journal-title":"J. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ostermann, H., Garau, J., Medina, J., Pascual, E., McBride, K., and Blasi, F. (2014). Resource use by patients hospitalized with community-acquired pneumonia in Europe: Analysis of the REACH study. BMC Pulm. Med., 14.","DOI":"10.1186\/1471-2466-14-36"},{"key":"ref_30","first-page":"82","article-title":"A survey on hospitalised community acquired pneumonia in Italy","volume":"65","author":"Migliorati","year":"2006","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.arbr.2012.12.003","article-title":"Improved management of community-acquired pneumonia in the emergency department","volume":"49","author":"Miguez","year":"2013","journal-title":"Arch. Bronconeumol."},{"key":"ref_32","unstructured":"(2022, October 17). Gazzetta Ufficiale Ministero Della Salute Decreto 18 Ottobre 2012. Available online: https:\/\/www.gazzettaufficiale.it\/eli\/id\/2013\/01\/28\/13A00528\/sg."},{"key":"ref_33","unstructured":"(2022, October 17). OBI Regional Tariffs (Campania, E.R., FVG, Lazio, Liguria, Bolzano, Veneto) Weighted for Resident Population (ISTAT 2020), Available online: https:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_3142_allegato.pdf."},{"key":"ref_34","unstructured":"(2023, February 09). EBM\u2014Uniform Standard Assessment 2022. Available online: https:\/\/www.kbv.de\/media\/sp\/EBM_Gesamt_-_Stand_4._Quartal_2022.pdf."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1183\/09031936.00083107","article-title":"Determinants of hospital costs in community-acquired pneumonia","volume":"31","author":"Reyes","year":"2008","journal-title":"Eur. Respir. J."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"L\u00f3pez, F., Catal\u00e0, M., Prats, C., Estrada, O., Oliva, I., Prat, N., Isnard, M., Vall\u00e8s, R., Vilar, M., and Clotet, B. (2021). A Cost-Benefit Analysis of COVID-19 Vaccination in Catalonia. Vaccines, 10.","DOI":"10.20944\/preprints202111.0435.v2"},{"key":"ref_37","unstructured":"(2022, October 17). DiaSorin SpA Market Research. Available online: https:\/\/diasoringroup.com\/sites\/diasorincorp\/files\/docs\/diasorin_en_0.pdf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1093\/jac\/dkm033","article-title":"Cost-effectiveness of empirical prescribing of antimicrobials in community-acquired pneumonia in three countries in the presence of resistance","volume":"59","author":"Martin","year":"2007","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_39","unstructured":"(2022, October 19). Orden de 17\/11\/2014, de la Consejer\u00eda de Sanidad Y Asuntos Sociales, Por la Que se Establecen Los Precios P\u00fablicos de la Asistencia Sanitaria Y de los Servicios Prestados en la Red de Centros Sanitarios Dependientes Del Servicio de Salud de Castilla-La Mancha. Available online: https:\/\/noticias.juridicas.com\/base_datos\/CCAA\/539877-orden-sanidad-y-asuntos-sociales-17-nov-2014-ca-castilla-la-mancha-precios.html."},{"key":"ref_40","unstructured":"(2022, October 17). Codifa L\u2019informatore Farmaceutico. Available online: https:\/\/www.codifa.it\/."},{"key":"ref_41","unstructured":"(2022, October 17). Rote Liste Arzneimittelinformationen f\u00fcr Deutschland. Available online: https:\/\/www.rote-liste.de\/."},{"key":"ref_42","unstructured":"(2022, October 17). Ministerio de Sanidad\u2014Profesionales de la Salud\u2014Nomenclator. Available online: https:\/\/www.sanidad.gob.es\/profesionales\/nomenclator.do."},{"key":"ref_43","first-page":"143","article-title":"[Community-acquired pneumonia: A budget impact model]","volume":"18","author":"Giusti","year":"2010","journal-title":"Infez. Med."},{"key":"ref_44","unstructured":"OECD (2022, October 20). Lorenzoni\u2014International Comparisons of Health Prices and Volumes: New Findings. Available online: https:\/\/www.oecd.org\/health\/health-systems\/International-Comparisons-of-Health-Prices-and-Volumes-New-Findings.pdf."},{"key":"ref_45","unstructured":"AGENAS (2022, October 21). Agenzia Nazionale per i Servizi Sanitari, Available online: https:\/\/www.agenas.gov.it\/."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2533","DOI":"10.1185\/03007990903209563","article-title":"Retrospective cost analysis of management of febrile neutropenia in cancer patients in Spain","volume":"25","author":"Mayordomo","year":"2009","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_47","unstructured":"Ministero della Salute (2022, October 20). Rapporto Annuale Sull\u2019attivit\u00e0 di Ricovero Ospedaliero (Dati SDO 2018), Available online: http:\/\/www.salute.gov.it\/portale\/documentazione\/p6_2_8_3_1.jsp?lingua=italiano&id=22."},{"key":"ref_48","unstructured":"(2022, October 21). InEK. Available online: https:\/\/www.g-drg.de\/."},{"key":"ref_49","unstructured":"(2022, October 21). Reimbursement Institute. Available online: https:\/\/reimbursement.institute\/."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.rmed.2016.11.023","article-title":"Viruses are prevalent in non-ventilated hospital-acquired pneumonia","volume":"122","author":"Shorr","year":"2017","journal-title":"Respir. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.amjms.2018.11.009","article-title":"Impact of Delayed Appropriate Antibiotic Therapy on Patient Outcomes by Antibiotic Resistance Status from Serious Gram-Negative Bacterial Infections","volume":"357","author":"Bonine","year":"2019","journal-title":"Am. J. Med. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1183\/09031936.00188710","article-title":"Initial management of pneumonia and sepsis: Factors associated with improved outcome","volume":"39","author":"Torres","year":"2012","journal-title":"Eur. Respir. J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/17476348.2019.1562339","article-title":"The burden of community-acquired bacterial pneumonia in the era of antibiotic resistance","volume":"13","author":"Peyrani","year":"2019","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_54","unstructured":"(2022, October 21). AIFA Antibiotico-Resistenza: Un Rischio Globale Che Richiede Strategie Condivise 2022, Available online: https:\/\/www.aifa.gov.it\/-\/antibiotico-resistenza-un-rischio-globale-che-richiede-strategie-condivise."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/3853\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:38:39Z","timestamp":1760121519000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/3853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":54,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20053853"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20053853","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,21]]}}}