Cost-Utility of Rapid Polymerase Chain Reaction-Based Influenza Testing for High-Risk Emergency Department Patients

Abstract

Study objective We evaluate the cost-effectiveness of polymerase chain reaction (PCR)-based rapid influenza testing and treatment for influenza in adult emergency department (ED) patients who are at high risk for or have evidence of influenza-related complications. Methods We developed a cost-utility decision analysis model that assessed adult patients presenting to the ED with symptoms of an acute respiratory infection, who met the Centers for Disease Control and Prevention criteria for recommended antiviral treatment. Analysis was performed from the societal perspective, with incremental comparisons of 4 influenza testing and treatment strategies: treat none, treat according to provider judgment, treat according to results of a PCR-based rapid diagnostic test, and treat all. Results Treating no patients with antivirals was dominated by all other strategies that increased in both cost and benefit in the following order: treat according to provider judgment, treat according to results of a PCR-based rapid diagnostic test, and treat all. As influenza prevalence increases, treating all patients eventually dominated all other options. Conclusion The economic benefit of incorporating use of rapid PCR-based influenza testing for ED patients at risk of developing influenza-related complications depends on influenza prevalence; treatment guided by physician diagnosis or rapid testing, and treatment of all patients is more effective and less costly than no treatment.

Potential Utility of Multiplex Amplification Respiratory Viral Panel Testing in the Management of Acute Respiratory Infection in Children: A Retrospective Analysis

“…These results support previously reported measurements of pandemic and nonpandemic influenza prevalence rates and the presence of many viral entities simultaneously [26][27][28][29]. These data highlight the need for accurate diagnosis of influenza among hospitalized children receiving oseltamivir, because empiric use may not be cost-effective depending on disease prevalence [30], and reducing unnecessary use would decrease exposure of patients to avoidable medication side effects [31].…”

Impact of rapid influenza PCR testing on hospitalization and antiviral use: A retrospective cohort study

“…With routine implementation in high-risk settings, it might be possible to consider a change in policy to test for influenza first before initiating antiviral therapy. However, use of rapid PCR-based influenza testing rather than treatment initiation alone is unlikely to be cost-effective based on drug costs alone, as demonstrated by prior modeling studies [Dugas et al, 2013]. In a typical season at our institution, the cost savings is only $4580; however, this does not include a potential reduction in hospital costs associated with earlier discontinuation of isolation precautions in those with rapid testing, which we were not able to measure in this retrospective study.…”

Point-of-care testing for respiratory viruses in adults: The current landscape and future potential

“…They concluded that PCR based rapid testing was the most cost effective strategy although this depended on the prevalence of influenza and again was based on strong assumptions of antiviral use and efficacy. 115 The potential benefits of POC testing for respiratory viruses in adults are listed in Table 3.…”