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Decision Tree — Pneumonia Site of Care (Expected Cost)

A cost-minimisation tree for low-risk community-acquired pneumonia: outpatient antibiotics, a 24-hour observation unit or admission, with treatment-failure admissions costed in — outpatient care rolls back to an expected $1,480 per patient against $3,080 for observation and $10,016 for admission. Illustrative values.

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Low-risk community-acquired pneumonia — where to treat?Low-risk community-acquired pneumonia — where to treat?Expected cost per patient with a CURB-65 score of 0–1, US$1 decision · 3 chance nodes · 7 outcomes · minimise E[cost]OPTIMAL STRATEGYOutpatient oral antibiotics·E[cost] $1,48024-hour observation unitcost $2,100 · net $3,080Inpatient admissioncost $9,800 · net $10,016Discharged home90%Admitted to a ward10%Uncomplicated stay97%Hospital-acquired infection3%At 24 hoursE[cost] $980$0net $2,100$9,800net $11,900Hospital stayE[cost] $216$0net $9,800$7,200net $17,000Outpatient oral antibioticscost $450 · net $1,480Recovers at home91.5%Fails, admitted to a ward8%Fails, admitted to ICU0.5%Site of careE[cost] $1,480Course at homeE[cost] $1,030$0net $450 · P 91.5%$10,500net $10,950 · P 8%$38,000net $38,450 · P 0.5%DecisionChanceOutcomeOptimal strategyRejected alternativeRisk profile·outcome distribution of the optimal strategy0%50%100%$0$5k$10k$15k$20k$25k$30k$35k$40kfinal cost91.5%8%0.5%E[cost]Expected cost$1,480Standard deviation$3,870Lowest cost$450Highest cost$38,450P(cost > expected)8.5%Distinct outcomes3What the rollback showsBest first choice: “Outpatient oral antibiotics”, E[cost] $1,480 — $1,600 below the next best, “24-hour observation unit”($3,080).Following it, the cost ranges from $450 to $38,450 across 3 possible results, standard deviation $3,870; an 8.5% chancethe cost exceeds its expectation.Note: Cost-minimisation: 30-day mortality is assumed equal across settings for CURB-65 0–1.Note: Illustrative costs for a fictional health system.

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title "Low-risk community-acquired pneumonia — where to treat?"
subtitle "Expected cost per patient with a CURB-65 score of 0–1, US$"
currency $
objective min
measure "E[cost]"
probabilities percent
branches orthogonal
risk-profile on
note "Cost-minimisation: 30-day mortality is assumed equal across settings for CURB-65 0–1."
note "Illustrative costs for a fictional health system."

decision "Site of care"
  "Outpatient oral antibiotics" cost 450 -> chance "Course at home"
    "Recovers at home" p rest -> 0
    "Fails, admitted to a ward" p 8% -> 10,500
    "Fails, admitted to ICU" p 0.5% -> 38,000
  "24-hour observation unit" cost 2,100 -> chance "At 24 hours"
    "Discharged home" p 90% -> 0
    "Admitted to a ward" p rest -> 9,800
  "Inpatient admission" cost 9,800 -> chance "Hospital stay"
    "Uncomplicated stay" p rest -> 0
    "Hospital-acquired infection" p 3% -> 7,200