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. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. Kathryn Schnippel & Naomi Lince-Deroche & Theo van den Handel & Seithati Molefi & Suann Bruce & Cynthia Firnhaber, 2015. "Cost Evaluation of Reproductive and Primary Health Care Mobile Service Delivery for Women in Two Rural Districts in South Africa," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-13, March.
    10. Rachel Elliott & Koen Putman & James Davies & Lieven Annemans, 2014. "A Review of the Methodological Challenges in Assessing the Cost Effectiveness of Pharmacist Interventions," PharmacoEconomics, Springer, vol. 32(12), pages 1185-1199, December.
    11. Abualbishr Alshreef & Michelle Jenks & William Green & Simon Dixon, 2016. "Review of Economic Submissions to NICE Medical Technologies Evaluation Programme," Applied Health Economics and Health Policy, Springer, vol. 14(6), pages 623-634, December.
    12. Yue Yin & Yusi Tu & Mingye Zhao & Wenxi Tang, 2022. "Effectiveness and Cost-Effectiveness of Non-Pharmacological Interventions among Chinese Adults with Prediabetes: A Protocol for Network Meta-Analysis and CHIME-Modeled Cost-Effectiveness Analysis," IJERPH, MDPI, vol. 19(3), pages 1-12, January.
    13. Huajie Jin & Paul Tappenden & Stewart Robinson & Evanthia Achilla & David Aceituno & Sarah Byford, 2020. "Systematic review of the methods of health economic models assessing antipsychotic medication for schizophrenia," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-18, July.
    14. S. Rajsic & H. Gothe & H. H. Borba & G. Sroczynski & J. Vujicic & T. Toell & Uwe Siebert, 2019. "Economic burden of stroke: a systematic review on post-stroke care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 107-134, February.
    15. B Ekman & H Nero & L S Lohmander & L E Dahlberg, 2020. "Costing analysis of a digital first-line treatment platform for patients with knee and hip osteoarthritis in Sweden," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-12, August.
    16. Stuart Wright & Cheryl Jones & Katherine Payne & Nimarta Dharni & Fiona Ulph, 2015. "The Role of Information Provision in Economic Evaluations of Newborn Bloodspot Screening: A Systematic Review," Applied Health Economics and Health Policy, Springer, vol. 13(6), pages 615-626, December.
    17. Fernando Hoces de la Guardia & Sean Grant & Edward Miguel, 2021. "A framework for open policy analysis," Science and Public Policy, Oxford University Press, vol. 48(2), pages 154-163.
    18. Nunn, Jack S & Shafee, Thomas, 2021. "Standardised Data on Initiatives – STARDIT: Beta Version," OSF Preprints w5xj6_v1, Center for Open Science.
    19. Jason Madan & Meghan Bruce Kumar & Miriam Taegtmeyer & Edwine Barasa & Swaran Preet Singh, 2020. "SEEP-CI: A Structured Economic Evaluation Process for Complex Health System Interventions," IJERPH, MDPI, vol. 17(18), pages 1-12, September.
    20. Jesse Elliott & Bláthnaid McCoy & Tammy Clifford & Beth K. Potter & George A. Wells & Doug Coyle, 2020. "Economic Evaluation of Cannabinoid Oil for Dravet Syndrome: A Cost-Utility Analysis," PharmacoEconomics, Springer, vol. 38(9), pages 971-980, September.

    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.