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Economic Analysis of Rapid and Sensitive Polymerase Chain Reaction Testing in the Emergency Department for Influenza Infections in Children

Nelson, Richard E. PhD*†; Stockmann, Chris MSc; Hersh, Adam L. MD, PhD; Pavia, Andrew T. MD; Korgenksi, Kent MS§; Daly, Judy A. PhD; Couturier, Marc R. PhD¶‖; Ampofo, Krow MD; Thorell, Emily A. MD; Doby, Elizabeth H. MD; Robison, Jeff A. MD; Blaschke, Anne J. MD, PhD

The Pediatric Infectious Disease Journal: June 2015 - Volume 34 - Issue 6 - p 577–582
doi: 10.1097/INF.0000000000000703
Original Studies

Background: Rapid multiplex polymerase chain reaction (PCR) assays simultaneously detect several respiratory viral pathogens with high sensitivity. Maximizing detection of influenza at the point of care has the potential to reduce unnecessary antibiotic use, laboratory tests and hospitalizations. However, the cost-effectiveness of rapid multiplex PCR assays for influenza has not been compared with other diagnostic methods in children.

Methods: For children presenting to the emergency department with influenza-like illness, we compared costs and outcomes using 4 different testing strategies for detection of influenza: (1) a rapid multiplex PCR platform (FilmArray); (2) traditional PCR; (3) direct-fluorescent antibody and (4) rapid antigen tests. Costs were assessed from the hospital perspective, and effectiveness was defined as quality-adjusted life years (QALYs). Input parameters were obtained from previous studies, and the model was run separately for children aged 3–36 months and 3–18 years.

Results: Rapid multiplex PCR testing was the most effective testing strategy for children in both age groups. The incremental cost-effectiveness when compared with rapid antigen tests was $115,556 per QALY for children aged 3–36 months and from $228,000 per QALY for children aged 3–18 years. The cost-effectiveness of rapid multiplex PCR was sensitive to estimates for influenza prevalence, the proportion of patients treated with antivirals and the cost per test.

Conclusions: Our model identifies scenarios in which identification of influenza in the emergency department using rapid multiplex PCR testing is a cost-effective strategy for infants and children 3 months through 18 years. Including detection of other respiratory viruses in the analysis would further improve cost-effectiveness.

Supplemental Digital Content is available in the text.

From the *IDEAS Center, Salt Lake City Veterans Affairs Health Care System, Salt Lake City, UT; Department of Internal Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; §Intermountain Healthcare, Pediatric Clinical Program, Salt Lake City, UT; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT; and Associated Regional and University Pathologists, Inc., Institute for Clinical and Experimental Pathology, Salt Lake City, UT

Accepted for publication November 14, 2014.

Funding for this study came from the National Institutes of Health and National Cancer Institute grant KM1CA156723 (R.E.N.) and the Department of Veterans Affairs grant CDA 11–210 (R.E.N.). This article is the result of work supported with resources and the use of facilities at the George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah. A.J.B., A.T.P., K.A. and A.L.H. collaborate with BioFire Diagnostics, Inc. on projects funded by the National Institutes of Health and the Centers for Disease Control and Prevention. A.J.B. has intellectual property in and receive royalties from BioFire Diagnostics, Inc. M.R.C. has received travel and research support from BioFire Diagnostics, Inc.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Richard E. Nelson, PhD, Salt Lake City Veterans Affairs Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148. E-mail: richard.nelson@utah.edu

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