Health Technology Assessment published on EUHEA conference. 2020 June 4
AUTHOR: Anne Voermans COAUTHORS: Janne Mewes, Tove Ofstad, Thorbjørn Halvorsen, Katalin Érsek, Lotte Steuten.
In Norway an average of 1.7% of the population is being diagnosed with influenza every year. New point-of-care (POC) tests for influenza A/B and RSV are available with excellent accuracy and turnaround time (TAT) of approximately 20 minutes, enabling physicians at the emergency room (ER) to quickly identify the right treatment and the need for isolating patients. The advantages of a POC test used in the ER include the shorter TAT compared to gold standard lab batch tests and improved sensitivity and specificity compared to other POC tests. As POC ER test results are available within a short timeframe, clinical management of patients can be improved. The objective of the current study was to evaluate the difference in cost of care of a POC test analysed directly at the ER (called POC ER) in comparison to a lab batch test.
Methods and assumptions:
A previously developed health economic model was adapted to the Norwegian ER setting, comparing the isolation and test costs per patient tested when using a POC ER test versus a lab batch test over a one-year time horizon from the healthcare perspective. The main outcome of the analysis was the combined total isolation and test costs per patient tested. Patients were ≥18 years of age presenting with unspecified lower respiratory symptoms in the ER, being tested for influenza A/B and RSV.
The decision on isolating patients was based on the sensitivity of the test when results were available upon admission (POC ER) or otherwise based on the physician´s suspicion (lab batch). Patients could therefore be isolated immediately upon admission, either necessarily or unnecessarily (when not having influenza A/B or RSV) or be isolated late. It was assumed results of the lab batch test were available with an average delay of 1.5 days. It was assumed 50% of isolated patients was isolated unnecessarily and 15% of the patients with influenza A/B or RSV were missed and isolated late when isolation was based on physician’s opinion in case test results were not available upon admission using the lab batch test.
For influenza A/B the average isolation and test costs per patient tested were expected to be €1,597 for the POC ER test and €3,289 for the lab batch test, indicating cost-savings of €1,692 (51.4%). For RSV the average isolation and test costs per patient tested were expected to be €601 for the POC ER and €1,219 for the lab batch test, indicating cost-savings of €618 (50.7%).
Although the POC ER comes with initial higher upfront test costs than a lab batch test, total downstream cost-savings were achieved through prevention of unnecessary isolation and avoiding late isolation. It is possible the latter will also prevent isolation of the entire multiple-bed patient room.