IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0242255.html
   My bibliography  Save this article

Point-of-care diagnostic tests for influenza in the emergency department: A cost-effectiveness analysis in a high-risk population from a Canadian perspective

Author

Listed:
  • Stephen Mac
  • Ryan O’Reilly
  • Neill K J Adhikari
  • Robert Fowler
  • Beate Sander

Abstract

Background: Our objective was to assess the cost-effectiveness of novel rapid diagnostic tests: rapid influenza diagnostic tests (RIDT), digital immunoassays (DIA), rapid nucleic acid amplification tests (NAAT), and other treatment algorithms for influenza in high-risk patients presenting to hospital with influenza-like illness (ILI). Methods: We developed a decision-analytic model to assess the cost-effectiveness of diagnostic test strategies (RIDT, DIA, NAAT, clinical judgement, batch polymerase chain reaction) preceding treatment; no diagnostic testing and treating everyone; and not treating anyone. We modeled high-risk 65-year old patients from a health payer perspective and accrued outcomes over a patient’s lifetime. We reported health outcomes, quality-adjusted life years (QALYs), healthcare costs, and net health benefit (NHB) to measure cost-effectiveness per cohort of 100,000 patients. Results: Treating everyone with no prior testing was the most cost-effective strategy, at a cost-effectiveness threshold of $50,000/QALY, in over 85% of simulations. This strategy yielded the highest NHB of 15.0344 QALYs, but inappropriately treats all patients without influenza. Of the novel rapid diagnostics, NAAT resulted in the highest NHB (15.0277 QALYs), and the least number of deaths (1,571 per 100,000). Sensitivity analyses determined that results were most impacted by the pretest probability of ILI being influenza, diagnostic test sensitivity, and treatment effectiveness. Conclusions: Based on our model, treating high-risk patients presenting to hospital with influenza-like illness, without performing a novel rapid diagnostic test, resulted in the highest NHB and was most cost-effective. However, consideration of whether treatment is appropriate in the absence of diagnostic confirmation should be taken into account for decision-making by clinicians and policymakers.

Suggested Citation

  • Stephen Mac & Ryan O’Reilly & Neill K J Adhikari & Robert Fowler & Beate Sander, 2020. "Point-of-care diagnostic tests for influenza in the emergency department: A cost-effectiveness analysis in a high-risk population from a Canadian perspective," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-15, November.
    • Handle: RePEc:plo:pone00:0242255
    DOI: 10.1371/journal.pone.0242255
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242255
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0242255&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0242255?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
    2. Marcelo Soto & Laura Sampietro-Colom & Anna Vilella & Efrain Pantoja & Maria Asenjo & Ruth Arjona & Juan Carlos Hurtado & Antoni Trilla & Miriam Jose Alvarez-Martinez & Aurea Mira & Jordi Vila & Maria, 2016. "Economic Impact of a New Rapid PCR Assay for Detecting Influenza Virus in an Emergency Department and Hospitalized Patients," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-10, January.
    3. W. Greiner & K. Lehmann & S. Earnshaw & C. Bug & R. Sabatowski, 2006. "Economic evaluation of Durogesic in moderate to severe, nonmalignant, chronic pain in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(4), pages 290-296, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Giovanna Elisa Calabrò & Sara Boccalini & Donatella Panatto & Caterina Rizzo & Maria Luisa Di Pietro & Fasika Molla Abreha & Marco Ajelli & Daniela Amicizia & Angela Bechini & Irene Giacchetta & Piero, 2022. "The New Quadrivalent Adjuvanted Influenza Vaccine for the Italian Elderly: A Health Technology Assessment," IJERPH, MDPI, vol. 19(7), pages 1-14, March.
    2. Saha, Sanjib & Gerdtham, Ulf-G. & Toresson, Håkan & Minthon, Lennart & Jarl, Johan, 2018. "Economic Evaluation of Interventions for Screening of Dementia," Working Papers 2018:20, Lund University, Department of Economics.
    3. Clarke, Lorcan, 2020. "An introduction to economic studies, health emergencies, and COVID-19," LSE Research Online Documents on Economics 105051, London School of Economics and Political Science, LSE Library.
    4. Najmiatul Fitria & Antoinette D. I. Asselt & Maarten J. Postma, 2019. "Cost-effectiveness of controlling gestational diabetes mellitus: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 407-417, April.
    5. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    6. Thomas Grochtdreis & Hans-Helmut König & Alexander Dobruschkin & Gunhild von Amsberg & Judith Dams, 2018. "Cost-effectiveness analyses and cost analyses in castration-resistant prostate cancer: A systematic review," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-25, December.
    7. Wendy Hens & Dirk Vissers & Nick Verhaeghe & Jan Gielen & Luc Van Gaal & Jan Taeymans, 2021. "Unsupervised Exercise Training Was Not Found to Improve the Metabolic Health or Phenotype over a 6-Month Dietary Intervention: A Randomised Controlled Trial with an Embedded Economic Analysis," IJERPH, MDPI, vol. 18(15), pages 1-13, July.
    8. Kim Edmunds & Penny Reeves & Paul Scuffham & Daniel A. Galvão & Robert U. Newton & Mark Jones & Nigel Spry & Dennis R. Taaffe & David Joseph & Suzanne K. Chambers & Haitham Tuffaha, 2020. "Cost-Effectiveness Analysis of Supervised Exercise Training in Men with Prostate Cancer Previously Treated with Radiation Therapy and Androgen-Deprivation Therapy," Applied Health Economics and Health Policy, Springer, vol. 18(5), pages 727-737, October.
    9. Andrew Gawron & Dustin French & John Pandolfino & Colin Howden, 2014. "Economic Evaluations of Gastroesophageal Reflux Disease Medical Management," PharmacoEconomics, Springer, vol. 32(8), pages 745-758, August.
    10. Saha, Sanjib & Gerdtham, Ulf-G. & Toresson, Håkan & Minthon, Lennart & Jarl, Johan, 2018. "Economic Evaluation of Nonpharmacological Interventions for Dementia Patients and their Caregivers - A Systematic Literature Review," Working Papers 2018:10, Lund University, Department of Economics.
    11. Frank G. Sandmann & Julie V. Robotham & Sarah R. Deeny & W. John Edmunds & Mark Jit, 2018. "Estimating the opportunity costs of bed‐days," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 592-605, March.
    12. Jesse Elliott & Sasha Katwyk & Bláthnaid McCoy & Tammy Clifford & Beth K. Potter & Becky Skidmore & George A. Wells & Doug Coyle, 2019. "Decision Models for Assessing the Cost Effectiveness of Treatments for Pediatric Drug-Resistant Epilepsy: A Systematic Review of Economic Evaluations," PharmacoEconomics, Springer, vol. 37(10), pages 1261-1276, October.
    13. Wei Zhang & Aslam Anis, 2014. "Health-Related Productivity Loss: NICE to Recognize Soon, Good to Discuss Now," PharmacoEconomics, Springer, vol. 32(5), pages 425-427, May.
    14. Katherine Edwards & Natasha Jones & Julia Newton & Charlie Foster & Andrew Judge & Kate Jackson & Nigel K. Arden & Rafael Pinedo-Villanueva, 2017. "The cost-effectiveness of exercise-based cardiac rehabilitation: a systematic review of the characteristics and methodological quality of published literature," Health Economics Review, Springer, vol. 7(1), pages 1-23, December.
    15. Don Husereau & Michael Drummond & Stavros Petrou & Dan Greenberg & Josephine Mauskopf & Federico Augustovski & Andrew Briggs & David Moher & Elizabeth Loder & Chris Carswell, 2015. "Reply to Roberts et al.: CHEERS is Sufficient for Reporting Cost-Benefit Analysis, but May Require Further Elaboration," PharmacoEconomics, Springer, vol. 33(5), pages 535-536, May.
    16. Nina van der Vliet & Anita W.M. Suijkerbuijk & Adriana T. de Blaeij & G. Ardine de Wit & Paul F. van Gils & Brigit A.M. Staatsen & Rob Maas & Johan J. Polder, 2020. "Ranking Preventive Interventions from Different Policy Domains: What Are the Most Cost-Effective Ways to Improve Public Health?," IJERPH, MDPI, vol. 17(6), pages 1-24, March.
    17. Simon van der Schans & Lucas M. A. Goossens & Melinde R. S. Boland & Janwillem W. H. Kocks & Maarten J. Postma & Job F. M. van Boven & Maureen P. M. H. Rutten-van Mölken, 2017. "Systematic Review and Quality Appraisal of Cost-Effectiveness Analyses of Pharmacologic Maintenance Treatment for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Recommendatio," PharmacoEconomics, Springer, vol. 35(1), pages 43-63, January.
    18. Andrew Briggs & Rachel Nugent, 2016. "Editorial," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 6-8, February.
    19. Don Husereau & Michael Drummond & Federico Augustovski & Esther Bekker-Grob & Andrew H. Briggs & Chris Carswell & Lisa Caulley & Nathorn Chaiyakunapruk & Dan Greenberg & Elizabeth Loder & Josephine Ma, 2022. "Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(8), pages 1309-1317, November.
    20. Neily Zakiyah & Antoinette D I van Asselt & Frank Roijmans & Maarten J Postma, 2016. "Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-19, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0242255. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.